bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of heat shock proteins in gastric mucosal protection
Authors: Rokutan Kazuhito
Published: March 2003

Heat shock proteins (HSP) are crucial for the maintenance of cellular homeostasis during normal cell growth and for survival during and after various cellular stresses. Gastric surface mucous cells are the first line of defence against insults derived from ingested foods and Helicobacter pylori infection. Primary cultures of gastric surface mucous cells from guinea‐pig fundic glands exhibited a typical heat shock response after exposure to elevated temperature or metabolic insults, such as ethanol and hydrogen peroxide, and they were able to acquire resistance to these stressors. Restraint and water immersion stress rapidly activated heat shock factor 1 (HSF1) in rat gastric mucosa within 15 min and induced HSP70 mRNA expression and its protein accumulation. The extent of the induction inversely correlated with the severity of mucosal lesions, suggesting an important role of HSP70 in gastric mucosal defence. This heat shock response appeared to be mediated by the α1A‐adrenoceptor. The HSP70 family functions as a molecular chaperone and reduces stress‐induced denaturation and aggregation of intracellular proteins. In addition to its chaperoning activities, HSP70 has been suggested to exert its cytoprotective action by protecting mitochondria and by interfering with the stress‐induced apoptotic programme. Recently, we introduced geranylgeranylacetone as a non‐toxic HSP70 inducer. This compound weakly stimulated HSP70 induction in cultured gastric mucosal cells and gastric mucosa by directly activating HSF1 and markedly augmented HSP70 induction in response to subsequent exposure to stress. Thus, non‐toxic HSP70 inducers may have a potential benefit for the prevention and treatment of stress ulcer.
Management of upper gastrointestinal haemorrhage
Authors: Lau James Yw , Chung Sydney
Published: March 2003

Abstract Endoscopic therapy is the first treatment modality in the management algorithm of upper gastrointestinal haemorrhage. In treating bleeding peptic ulcers, diluted epinephrine is first injected followed by targeted treatment to the vessel. Combination therapy adding thermocoagulation or thrombin/fibrin products has been shown to further improve the rate of haemostasis. There is also some evidence to suggest that adjuvant use of optimal acid suppression using high‐dose proton pump inhibitors can reduce recurrent bleeding after initial endoscopic control. In treating acute variceal haemorrhage, early administration of vasoactive agents facilitates endoscopic treatment. These drugs should be continued during and after endoscopic therapy to prevent recurrent in‐hospital bleeding. Firm evidence exists to date that band ligation is the endoscopic treatment of choice in the acute control of bleeding varices and their secondary prophylaxis against recurrent bleeding. The role of band ligation as primary prophylaxis for first bleeding remains controversial. Transjugular intrahepatic porto‐systemic shunts are used as a rescue procedure when endoscopic treatment fails. In selected patients with recurrent variceal haemorrhage and good hepatic reserves, surgical shunts may be indicated.
Helicobacter pylori: Past, present and future
Authors: Tytgat Gnj
Published: March 2003

Abstract Much has been achieved in Helicobacter pylori research, to the point that the growth of new knowledge is bound to slow down. However, expectations for further developments remain high. Knowledge about the characteristic organism and behaviour is already extensive. Particularly intriguing are the differences in genetic make‐up in the various geographical regions. Sadly, detailed knowledge on how the organism spreads is still lacking. The spectrum of clinical presentation in humans is largely known. Helicobacter pylori is disappearing worldwide, allowing the relative frequency of H. pylorin‐egative ulcer disease to increase. The extent to which H. pylori disappearance and eradication is responsible for decreasing prevalence of gastric cancer remains speculative. Antimicrobial therapy is dominated by proton pump inhibitor triple therapy as first line therapy, with quadruple therapy as second rescue line therapy. The long‐term consequences of the rising resistance to the ‘key’ antimicrobials are so far unknown, because few data are available on therapeutic outcomes in routine practice outside pharmaceutical trials.
Fading boundary between gastroenterology and surgery
Authors: Cotton Peter B
Published: March 2003

Abstract The developments of minimally invasive surgery and therapeutic endoscopy have blurred the traditional distinctions between surgical and medical disciplines. Maintenance of the time‐honoured separation of surgery and medicine now hinders the full flowering of innovative interventions. Patient care, clinical research and education in digestive disorders require structural realignment, as is being attempted in the Digestive Disease Center at the Medical University of South Carolina.
Disinfection of gastrointestinal endoscopes and accessories
Authors: Tandon Rakesh K
Published: March 2003

Abstract A worldwide concern has emerged with regard to endoscope disinfection and many gastrointestinal endoscopy associations have developed guidelines for proper disinfection of endoscopes and endoscopic accessories. A working party was convened to formulate guidelines for the Asia–Pacific region, pertaining to any setting in which gastrointestinal endoscopy is performed. Endoscope reprocessing that meets the established standard of practice helps to ensure a microbial‐free endoscope for all patients, reduces the risk of disease transmission and helps to prolong the life of the endoscope. The recommendations included mechanical cleaning as the first and most important step followed by immersion in 2% glutaraldehyde for a minimum period of 10 min. Automated disinfectors have been recommended for busy endoscopy centres to ensure better compliance. Reuse of endoscopic accessories meant for ‘single use’ remains a controversial issue. Strict quality assurance programmes are a must to preclude lack of compliance with these guidelines.
Analysis of K‐ras codon 12 mutations and p53 overexpression in colorectal nodule‐aggregating tumors
Authors: Kusaka Toshihiro , Fukui Hirokazu , Ueda Yoshihiko , Chiba Tsutomu , Fujimori Takahiro
Published: March 2003

Abstract Background and Aims: Morphologically, colorectal nodule‐aggregating tumors are quite different from polypoid‐type colorectal tumors that develop via the adenoma–carcinoma sequence. Although polypoid‐type colorectal tumors are well known to have a high incidence of K‐ras gene mutation and p53 overexpression, colorectal nodule‐aggregating tumors have not been examined in terms of genetic changes and clinicopathological features. In the present study, therefore, we analysed the clinicopathological features, genetic changes in K‐ras codon 12, and p53 overexpression in colorectal nodule‐aggregating tumors.

Methods: A total of 18 colorectal nodule‐aggregating tumors were surgically resected and then analysed clinicopathologically. Immunohistochemistry and polymerase chain reaction–single stranded conformational polymorphism were performed to analyse p53 abnormalities in the tumors. K‐ras codon 12 mutations were screened out by the polymerase chain reaction–restriction fragment length polymorphism method and analysed by fluorescence direct sequencing.

Results: p53 overexpression was observed in six lesions (33%). p53‐overexpressing cells were observed in parts of carcinoma or adenoma showing high‐grade atypia. Four of the 10 (40%) samples had a p53 gene mutation. Nine of the 18 (50%) samples had a K‐ras codon 12 point mutation. In eight cases (89%), the mutations of the K‐ras codon 12 were of the same type: GGT (glycine) to GTT (valine).

Conclusions: The colorectal nodule‐aggregating tumor has distinctive characteristics showing a morphological phenotype of the superficial‐type tumors and genotype of the polypoid tumors in terms of K‐ras gene mutation and p53 overexpression.
Adult coeliac disease: Prevalence and clinical significance
Authors: Cook H Bramwell , Burt Michael J , Collett Judith A , Whitehead Martin R , Frampton Christopher Ma , Chapman Bruce A
Published: March 2003

Background and Aims
: Although coeliac disease is a common condition, the role of population screening is not clear. The aim of this study was to determine the prevalence and clinical significance of coeliac disease in the adult population of Christchurch, New Zealand.

Methods
: A total of 1064 adults randomly selected from the 1996 Christchurch electoral rolls were enlisted. The subjects were screened for coeliac disease using the anti‐endomysial antibody test (EMA), and all those with positive tests were reviewed and underwent a small bowel biopsy.

Results
: Twelve of the 1064 persons tested (1.1%) were EMA positive and all had small bowel biopsy histology consistent with coeliac disease. Two of the 12 subjects were previously known to be EMA positive although neither had a small bowel biopsy. One additional subject with known and treated coeliac disease was also enrolled but was EMA negative. Thus, the overall prevalence of coeliac disease was 13 of 1064 subjects (1.2%, or 1 : 82), 10 of whom were newly diagnosed (0.9%, or 1 : 106) and three were previously known or suspected to have coeliac disease (0.3%, or 1 : 355). The prevalence in both sexes was similar. Nine of the 12 EMA‐positive coeliac disease subjects identified by the use of screening reported symptoms, of which tiredness and lethargy were the most common. The subjects were of normal stature, although females tended to be lean. None of the subjects were anaemic, but four were iron deficient and four folate deficient. Five of the 12 had sustained bone fractures. Bone mineral density was reduced in males but not in females.

Conclusions
: The prevalence of coeliac disease in the adult population of Christchurch, New Zealand, is 1.2%. Unrecognized coeliac disease which was detected by population screening was three‐fold more common than proven or suspected coeliac disease. Population screening may identify subjects who could benefit from treatment.
Herbal hepatotoxicity: An expanding but poorly defined problem
Authors: Chitturi Shivakumar , Farrell Geoffrey C
Published: March 2003

Abstract Alternative therapies, including herbal remedies, are popular in the general population and even more so among patients with liver disease. The use of such products is now well established in western society and is no longer confined to traditional medicine practitioners in Asia, Africa and the Middle‐East. Their perceived benefits remain generally unproven and concern about adverse effects is leading to closer scrutiny of these products. Herbal hepatotoxicity has been recognized for many years, but new agents are constantly being identified. The varied manifestations of liver injury include steatosis, acute and chronic hepatitis, hepatic fibrosis, zonal or diffuse hepatic necrosis, bile duct injury, veno‐occlusive disease, acute liver failure requiring liver transplantation and carcinogenesis. Potential interactions between herbal medicines and conventional drugs may interfere with patient management. Concurrent use of such products is not often disclosed unless specifically sought after and can lead to perpetuation of the liver injury. The present review focuses on emerging herbal hepatotoxins, newer patterns of liver injury among the older agents and provides an updated tabulation of the adverse effects of major herbal hepatotoxins. Key issues of diagnosis and prevention of this growing problem are addressed. Continued public education, physician awareness and more stringent licensing are required to tackle this growing problem.
Evaluation of miniature manometric techniques for the measurement of esophageal body pressure waves
Authors: Shanmuganathan Ganes , Ritz Marc A , Holloway Richard H , Matteo Addolorata C Di , Omari Taher I
Published: March 2003

Background and Aims

Perfused miniature manometric assemblies with lumina of 0.4–0.5 mm i.d. have been developed. Reduced luminal size offers the advantages of reduced assembly bulk and increased assembly complexity with greater numbers of lumina and lower manometric infusion volumes because of a slower perfusion rate. This study investigated the recording fidelity of miniature manometric assemblies in the measurement of esophageal peristalsis.

Methods

Four miniature manometric assemblies, each containing manometric lumina of either 0.4 or 0.5 mm i.d., were evaluated at 100 and 180 cm lengths. The fidelity of miniature manometric luminal recordings were evaluated in vivo during esophageal peristalsis by using a simultaneous comparison with the standard lumina and an intraluminal strain gauge.

Results

During esophageal peristalsis, miniature manometric lumina recorded the peak amplitude of pressure waves, with an accuracy at perfusion rates of 0.04 mL/min (0.4 mm, i.d) and 0.15 mL/min (0.5 mm, i.d.).

Conclusion

Miniature manometric assemblies of lengths that are practical for use in humans are suitable for recording esophageal peristalsis.
Changes in titers of antimitochondrial and antinuclear antibodies during the course of primary biliary cirrhosis
Authors: Masuda Jun‐Ichi , Omagari Katsuhisa , Matsuo Isao , Kinoshita Hideki , Sakimura Kanae , Hazama Hiroaki , Ohba Kazuo , Isomoto Hajime , Murase Kunihiko , Murata Ikuo , Kohno Shigeru
Published: March 2003

Abstract A case of primary biliary cirrhosis (PBC) in whom a complete biochemical (serum bilirubin, transaminases and alkaline phosphatase) remission was noted after combination treatment with ursodeoxycholic acid (UDCA) and corticosteroid is reported. The antimitochondrial antibody (AMA) detected by indirect immunofluorescence was initially positive, and the antinuclear antibody (ANA) was negative, but these two antibodies subsequently fluctuated independently (AMA‐positive/ANA‐negative, AMA‐negative/ANA‐negative, AMA‐negative/ANA‐positive, AMA‐positive/ANA‐positive, and again AMA‐negative/ANA‐positive) in spite of a lack of histopathological improvement in the liver after treatment. The clinical presentation in our case suggests that in some cases the diagnosis of PBC or so‐called autoimmune cholangitis (AIC) might depend on the ‘phase’ of the same disease. Our results also suggest that detailed immunoreactive profiles against 2‐oxo‐acid dehydrogenase complex (2‐OADC) enzymes by using immunoblotting, together with a serial histological examination, should provide more precise information for a diagnosis of PBC.
New hepatitis viruses: Contenders and pretenders
Authors: Bowden Scott
Published: March 2003

Abstract Following the development of tests for hepatitis C virus and hepatitis E virus infection, it became clear that there remained cases of hepatitis that were non‐A‐E. Such cases provided impetus for the search for additional hepatitis viruses and, by using molecular techniques, several candidates were identified. An enteric agent responsible for sporadic non‐A and non‐E hepatitis was tentatively called hepatitis F virus. However, the lack of any corroborating reports has cast doubt on its status as a true hepatitis virus. Two groups independently reported the isolation of a blood‐borne virus, designated as hepatitis G virus (HGV) and GB virus C (GBV‐C) by their respective discoverers. They were later shown to be isolates of the same virus. While the virus has a high prevalence in cases of non‐A‐E hepatitis, it also has a high prevalence in the appropriate control groups and convincing evidence for its replication in the liver is lacking. Another possible hepatitis virus, TT virus, was discovered in the blood of a patient with post‐transfusion non‐A‐E hepatitis. By using PCR primers designed to overcome the high nucleotide sequence divergence, TT virus was found to be ubiquitous with a worldwide distribution. A disease association is thus unlikely. Most recently, a DNA virus designated as SEN‐V has been announced as a major cause of non‐A‐E hepatitis. Based on limited data available to researchers, SEN‐V is the most convincing contender for the new hepatitis virus title. However, the lessons learnt from the hepatitis virus pretenders will need to be applied to SEN‐V and any future contenders.
A meta‐analysis of peritoneal lavage for acute pancreatitis
Authors: Platell Cameron , Cooper Debora , Hall John C
Published: March 2003

Background and Aim:

It has been postulated that continuous irrigation of the peritoneal cavity with crystalloid solutions in patients with acute pancreatitis can improve mortality and morbidity. The aim of the study is to perform a meta‐analysis of available randomized prospective clinical trials, to evaluate whether lavage influences mortality and morbidity in patients with acute pancreatitis.

Methods:

We performed a computer search of Medline for all available literature on the use of lavage in patients with acute pancreatitis. A meta‐analysis was conducted on eight randomized, prospective, clinical trials (a total of 333 patients) evaluating continuous peritoneal lavage in patients with acute pancreatitis. The end‐points were mortality and morbidity (i.e. pancreatic necrosis, peripancreatic fluid collections, intra‐abdominal abscess formation, septicemia, organ system failure).

Results:

Continuous lavage did not improve either mortality (weighted mean difference 1.6%, 95% CI –6.7% to 9.9%, not significant (n.s.)) or morbidity (weighted mean difference 6.2%, 95% CI –3.2% to 15.6%, n.s.) when compared with control patients.

Conclusions:

The use of continuous peritoneal lavage in patients with acute pancreatitis has not been found to be associated with any significant improvement in mortality or morbidity.
Ligation of the Fas antigen stimulates chemokine secretion in pancreatic cancer cell line PANC‐11
Authors: Shimada Mitsue , Andoh Akira , Araki Yoshio , Fujiyama Yoshihide , Bamba Tadao
Published: March 2003

Background and Aim: The role of chemokines in the process of immune cell infiltration into pancreatic cancer tissue has been reported. In this study, we investigated the induction of chemokines (interleukin (IL)‐8 and monocyte chemoattractant protein (MCP)‐1) by Fas antigen (Ag)‐stimulation in a human pancreatic cancer cell line, PANC‐1.

Methods: The chemokine secretion was evaluated by using an ELISA and a northern blot, and the activation of nuclear factor‐κB (NF‐κB) was assessed by using an electrophoretic gel mobility shift assay (EMSA).

Results: The Fas antigen (Ag) stimulation clearly induced an increase in IL‐8 and MCP‐1 secretion in PANC‐1 cells. This effect was also observed at the mRNA level. The induction of chemokine secretion by Fas Ag stimulation required de novo gene expression and protein synthesis. The pretreatment with interferon (IFN)‐γ markedly enhanced the effects of Fas Ag stimulation; IFN‐γ pretreatment and Fas Ag stimulation synergistically induced not only apoptosis but also IL‐8 and MCP‐1 secretion. Flow cytometric analysis demonstrated that IFN‐γ significantly enhanced Fas Ag expression. In addition, Fas Ag stimulation actually evoked NF‐κB activation in this cell line.

Conclusion: Our results indicate that Fas Ag stimulation can induce chemokine secretion in PANC‐1 cells, suggesting the contribution of Fas stimulation to the accumulation of immune cells in pancreatic cancer tissue.
Fatigue and psychological disorders in chronic hepatitis C
Authors: MCDONALD JENNIFER , JAYASURIYA ROHAN , BINDLEY PATRICIA , GONSALVEZ CRAIG , GLUSESKA SONJA
Published: March 2003

Background and AimMost patients with chronic hepatitis C report that they suffer from fatigue. The aim of this study was to determine if the symptom of fatigue can be a guide to indicate disease activity in chronic hepatitis C, or if it is related to psychological factors.

Methods115 chronic hepatitis C patients attending a liver clinic at Wollongong Hospital, Wollongong, Australia, were asked to fill out a questionnaire on the functional impact of their fatigue, and a questionnaire on psychological parameters. These were correlated with a history of intravenous drug use, alcohol history, transaminase levels and liver biopsy findings.

ResultsFatigue weakly correlated with the level of fibrosis on the liver biopsy, but strongly correlated with all the psychological domains of depression, anxiety, somatization, interpersonal sensitivity and hostility.

ConclusionThe level of fatigue strongly correlated with all the psychological domains, particularly depression, and not with our measures of disease activity.
Xanthine oxidase‐derived oxygen radicals play significant roles in the development of chronic pancreatitis in WBN/Kob rats
Authors: ZEKI SHIGEYUKI , MIURA SOICHIRO , SUZUKI HIDEKAZU , WATANABE NAOYUKI , ADACHI MASAYUKI , YOKOYAMA HIROKAZU , HORIE YOSHINORI , SAITO HIDETSUGU , KATO SHINZO , ISHII HIROMASA
Published: March 2003

Abstract

Background:
Although oxygen‐derived free radicals are known to play a role in cell injury and DNA alterations, the role of active oxidants in chronic pancreatitis has not been fully elucidated. Using WBN/Kob rats, which spontaneously develop chronic pancreatitis‐like lesions, we investigated whether xanthine oxidase (XOD)‐derived oxygen radicals are involved in pancreatic tissue injury.

Methods:
WBN/Kob rats were fed a control or a tungsten diet. The latter depletes XOD activity. Histologic al changes, glutathione (GSH) content and XOD and superoxide dismutase (SOD) activities were determined in pancreatic tissue. Pancreatic 8‐hydroxy‐deoxyguanosine (8‐OH‐dG) levels and lithostathine mRNA were also examined.

Results:
In WBN/Kob rats, parenchymal destruction and fibrosis developed at approximately 12 weeks of age and progressed with each month. The activity of XOD was significantly higher in the early period (8–12 weeks), whereas the levels of GSH and SOD decreased after 16 weeks. Levels of 8‐OH‐dG in WBN/Kob rats were significantly elevated at 16 weeks. Lithostathine mRNA levels started to increase at 8 weeks, but were suppressed at 16 weeks. The tungsten diet significantly attenuated the histological changes in WBN/Kob rats. The increase in pancreatic XOD activity and 8‐OH‐dG content in WBN/Kob rats was significantly inhibited by the tungsten diet and lithostathine mRNA levels remained high at 16 weeks.

Conclusion:
These results suggest that oxygen radicals generated by XOD play an important role in oxidative DNA damage and the development of chronic pancreatic injury.

© 2002 Blackwell Publishing Asia Pty Ltd
Management of patients with chronic hepatitis B
Authors: Liaw Yun‐Fan
Published: March 2003

Abstract  Better understanding of hepatitis B virus (HBV) replication and the natural history and immunopathogenesis of chronic hepatitis B, together with the introduction of effective agents with different mechanisms of action, is the basis for better therapeutic strategies against chronic hepatitis B. Substantial experience has now been accumulated in the use of some of these drugs, and an Asia–Pacific Consensus has been reached on indications for their use. The goals of therapy and aspects of general management will be reviewed here. Among currently available drugs, α‐interferon therapy gives a response rate (hepatitis B e antigen (HBeAg) seroconversion) of 30–40% compared with 10–20% in matched controls, but patients with lower alanine aminotransferase (ALT), higher HBV‐DNA, and immunosuppressed patients have a poorer response, and α‐interferon can be dangerous in cirrhosis. Meta‐analysis of four controlled trials also suggests that thymosin‐α1 is effective, but more studies are needed. Lamivudine has been most extensively studied. It is effective in terms of HBV‐DNA loss, ALT normalization, HBeAg seroconversion, and improvement in histology, as well as being well tolerated. After 1 year of treatment, HBeAg seroconversion rate increased with higher pretherapy ALT levels, suggesting that patients with stronger endogenous antiviral defenses to kill hepatocytes haboring covalently closed circular DNA have a better response to direct antiviral effects. Lamivudine is also beneficial in HBeAg negative chronic hepatitis B, and patients with decompensated cirrhosis and HBV replication. However, genotypic‐resistant tyrosine‐methionine‐aspartate‐aspartate (YMDD) mutations start to emerge after 9–10 months of lamivudine therapy, and their incidence increases more quickly than the HBeAg seroconversion rate durating prolonged therapy. Thus the benefits of long‐term lamivudine must be balanced against concern about YMDD mutations, and the durability of treatment response. There are encouraging preliminary results for adefovir dipivoxil, entecavir, emtricitabine, clevudine and other nucleoside/nucleotide analogs in the early stages of appraisal; entecavir and adefovir dipivoxil appear effective in patients with YMDD mutants. Further development of new drugs and new strategies, such as combination or sequential therapy, may help to better achieve the goals of treatment for chronic hepatitis B in the new century.

© 2002 Blackwell Publishing Asia Pty Ltd
Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: A controlled study
Authors: ZHOU YONGNING , QIAO LIANG , WU JING , HU HAIWEN , XU CAIPU
Published: March 2003

Background: Portal hypertensive gastropathy is an important complication of liver cirrhosis and it contributes to acute gastric bleeding. Effective management of this condition remains a clinical challenge. We assessed and compared the efficacy of octreotide, vasopressin, and omeprazole in the treatment of acute bleeding in patients with portal hypertensive gastropathy.

Methods: Sixty‐eight patients with portal hypertensive gastropathy were randomized into Octreotide, Vasopressin, and Omeprazole groups. Bleeding was monitored by observing the contents of the nasogastric tube. Blood transfusion requirements and side‐effects of drugs were recorded. Repeat endoscopies were scheduled 2 weeks after treatment.

Results: Complete bleeding control after 48 h of drug infusion was achieved in all patients receiving octreotide (100%), 14/22 patients receiving vasopressin (64%), and 13/22 patients receiving Omeprazole (59%). Octreotide required much less time and significantly fewer blood transfusions to control bleeding. Patients receiving vasopressin experienced more side‐effects than those receiving octreotide and omeprazole. In the 17 patients whose bleeding was not controlled within 48 h by either vasopressin or omeprazole, complete bleeding control was achieved by combined use of these two agents. Follow‐up endoscopy showed dramatic improvement in gastric mucosal erosions, superficial ulceration and erythema.

Conclusions: Octreotide appeared to be more effective in controlling acute bleeding in patients with hypertensive gastropathy, with significantly rapid action, smaller transfusion requirements, and minor side‐effects. Simultaneous administration of vasopressin and omeprazole appeared to have additive effects.

© 2002 Blackwell Publishing Asia Pty Ltd
Genotype‐specific mechanisms for hepatic steatosis in chronic hepatitis C infection
Authors: Hui Jason M , Kench James , Farrell Geoffrey C , Lin Rita , Samarasinghe Dev , Liddle Christopher , Byth Karen , George Jacob
Published: March 2003

Abstract Background: Hepatic steatosis is common in hepatitis C, but the relative importance of host and viral factors is controversial. In the present prospective study, we examined metabolic factors associated with non‐alcoholic fatty liver and viral genotype as predictors of steatosis and fibrosis in chronic hepatitis C infection.

Methods: In 124 chronic hepatitis C patients, the association between liver histology and the following was investigated: demographic and anthropometric data, alcohol intake, alanine aminotransferase (ALT), total cholesterol, low‐density lipoprotein–cholesterol, high‐density lipoprotein–cholesterol, triglyceride, transferrin saturation, ferritin, insulin, c‐peptide, glucose and insulin resistance (homeostasis model).

Results: By multivariate analysis, genotype 3 was associated with increased steatosis grade (P
= 0.02). There were significant pairwise interactions between genotype 3 status and total cholesterol (P
= 0.01), current alcohol intake (P
= 0.04) and serum ALT (P
= 0.01). This showed that the etiology of steatosis was different in patients with genotype 3 and those with non‐genotype 3 chronic hepatitis C infection. In genotype 3 patients, the degree of steatosis was inversely associated with serum cholesterol (P
= 0.005) and positively associated with serum triglyceride (P
= 0.02). There was no association between body mass index (BMI) and the extent of steatosis. Among patients with other genotypes, the steatosis grade was strongly influenced by BMI (P < 0.0001) and serum ALT (P < 0.01). Independent predictors of fibrosis were age (P
= 0.001), past alcohol intake (P
= 0.04), ALT (P
= 0.002), serum insulin (P
= 0.001) and portal inflammation (P < 0.001).

Conclusions: Hepatitis C genotype 3 may interfere with pathways of hepatic lipid metabolism, whereas increased BMI appears to be a more important pathogenic factor in other genotypes. Although steatosis and BMI were not associated with hepatic fibrosis, their relationship with serum insulin suggests that metabolic factors related to insulin action could influence fibrogenesis in hepatitis C.
Prevalence of irritable bowel syndrome in Hong Kong
Authors: Kwan Ambrose Chi‐Pong , Hu Wayne Hsing‐Cheng , Chan Yiu‐Kay , Yeung Yat‐Wah , Lai Thomas Sik‐To , Yuen Hon
Published: March 2003

Background and Aims:
As part of a public education program, the Hong Kong Society of Gastrointestinal Motility studied the prevalence of irritable bowel syndrome (IBS) in the community, which was based on the recently published Rome II criteria. The distribution of diarrhea or constipation‐predominant IBS subtypes, the prevalence of bowel symptoms and the predictors of health‐care seeking were also studied.

Methods:
Among 1797 randomly selected respondents, 1000 successful telephone interviews (56%) were conducted from August 2000 to December 2000, using a validated questionnaire in Chinese that looked into demographic data and various bowel symptoms during the past year.

Results:
The 12‐month prevalence of IBS as defined by the Rome II criteria in Hong Kong was 6.6%. The female to male ratio was 1.3:1, but this ratio was the same in the control group. The distribution of IBS patients into diarrhea predominant, constipation predominant, and non‐specific subtypes was 27, 17 and 56%, respectively. The predominant symptom in the IBS group was pain (54.5%), followed by urgency (15%), abdominal distension (15%) and diarrhea (11%). Forty‐seven percent of IBS patients sought medical attention and only 21% of them knew that they had IBS. Moderate to severe pain severity (odds ratio 3.7, 95% CI 1.02–13) and mucus in stool (odds ratio 3.57, 95% CI 1.18–10.7) were associated with health‐care seeking in univariate analysis. The prevalence of bowel symptoms such as urgency, straining, feeling of incomplete defecation, mucus in stool and abdominal distension ranged from 11 to 41%.

Conclusion:
The prevalence of IBS in Hong Kong was 6.6%, and the female to male ratio was similar to the control group. The majority was of non‐specific IBS subtype. Gross underdiagnosis (21%) by Western practitioners was noted.

© 2002 Blackwell Publishing Asia Pty Ltd
Preoperative assessment of hepatic function: Utility of a new convenient two‐compartment model analysis using galactosyl human serum albumin scintigraphy
Authors: KINOSHITA KOICHI , UKIKUSA MINORU , IWAISAKO KEIKO , ARIMOTO AKIRA , FUJISAWA NORIYOSHI , OZAKI TAKESHI , TANAKA HIRONORI , SEO SATOSHI , NAITOH MASATO , NOMURA AKINARI , INOMOTO TAKUYA , KITAI TOSHIYUKI , INO KEIICHI , HIGASHIYAMA HIROSHI , HANAFUSA TETSUJI , NAKAJIMA YASUO
Published: March 2003

Background and Aim: Preoperative hepatic function was evaluated using technetium‐99 m‐diethylenetriaminepenta‐acetic acid‐galactosyl‐human serum albumin (Tc‐GSA) and a scintillation camera to detect hepatic Tc‐GSA uptake by the asialoglycoprotein receptor.

Methods: Sixty‐two preoperative patients with liver cancer, including hepatocellular and cholangiocellular carcinomas, were studied, using two‐parameter two‐compartment model analysis. This model is simpler than either the three‐ or five‐compartment model, both of which are accurate but which require complicated analysis and enormous calculation. The parameters k1 and k2 represented the transfer rate constant from the blood to the liver and from the liver to the blood, respectively. We calculated k1, k2, and k1/k2 from time‐radioactivity curves of the heart and liver as well as VLmg, which represented the maximal amount of Tc‐GSA in the liver.

Results: The results were compared to those of conventional liver function analysis using Tc‐GSA (the index of blood clearance (HH15) and the receptor index (LHL15)) or indocyanine green (ICGR15). Both HH15 and LHL15 were significantly correlated with k1, k1/k2, and VLmg. In addition, they closely correlated with the results of ICGR15 and some serum hepatic function tests (aspartate aminotransferase, choline esterase, albumin, platelet). The pathological grading for liver cirrhosis also correlated with k1, k1/k2, and VLmg. From a clinical point of view, VLmg had a significant correlation with the Child–Pugh score.

Conclusions: These results suggest that this new compartment analysis will be useful in evaluating liver function, as it is accurate, simple and convenient.

© 2003 Blackwell Publishing Asia Pty Ltd
Impaired expression of proteasome subunits and human leukocyte antigens class I in human colon cancer cells
Authors: MIYAGI TAKUYA , TATSUMI TOMOHIDE , TAKEHARA TETSUO , KANTO TATSUYA , KUZUSHITA NORIYOSHI , SUGIMOTO YOSHIKO , JINUSHI MASAHISA , KASAHARA AKINORI , SASAKI YUTAKA , HORI MASATSUGU , HAYASHI NORIO
Published: March 2003

Background and Aim: The presentation of human leukocyte antigens (HLA) class I requires the coordinated expression of numerous components involved in antigen processing and antigen presentation. Tumor cells may alter the expression of these components to decrease HLA class I expression, allowing them to escape immune surveillance. The aim of this study is to investigate the expressions of these components, including proteasome subunits, and their involvement in the expression of HLA class I in human colon cancer cells.

Methods: Four human colon cancer cell lines, HCT116, SW403, LoVo and DLD‐1, were used to examine the expression of HLA class I by flow cytometry. Reverse transcription–polymerase chain reaction was performed to assess the expression of β2‐microglobulin, heavy chains, transporter subunits, immunoproteasomes subunits and proteasome activator 28 (PA28) subunits.

Results: Human leukocyte antigen class I was expressed highly in HCT116 and SW403 cells and weakly in LoVo cells, but was not expressed in DLD‐1 cells. The DLD‐1 cells were deficient in the expression of proteasome subunits including low molecular weight polypeptide proteasome subunit 2 (LMP2), multicatalytic endopeptidase complex‐like‐1 (MECL‐1), PA28α and PA28β, whereas other HLA class I‐expressing cell lines expressed all components tested. γ‐Interferon (IFN‐γ) treatment of DLD‐1 cells restored the expression of LMP2, MECL‐1 and PA28β, but not the expression of HLA class I. Enforced expression of PA28α induced the expression of HLA class I in IFN‐γ‐treated DLD‐1 cells, but not in untreated DLD‐1 cells.

Conclusion: These results suggest that the impaired expression of proteasome subunits is involved in the loss of HLA class I expression in human colon cancer cells.

© 2003 Blackwell Publishing Asia Pty Ltd
Meta‐analysis of randomized controlled trials on the benefits and risks of using cisapride for the treatment of gastroesophageal reflux in children
Authors: DALBY‐PAYNE JACQUELINE R , MORRIS ANNE M , CRAIG JONATHAN C
Published: March 2003

Background and Aim:  Gastroesophageal reflux is a common problem in infancy. Cisapride is a commonly used therapy for gastroesophageal reflux in children. In view of recent concern regarding adverse effects this study aims to evaluate the benefits and risks of cisapride for the treatment of gastroesophageal reflux in children.

Methods:  A meta‐analysis of randomized controlled trials of cisapride using a random‐effects model.

Results:  Ten trials involving 415 children were identified. There was no evidence of a significant reduction in vomiting severity with cisapride as measured by a clinical score (five trials, standardized weighted mean difference −0.18; 95% confidence interval (CI) −0.51 to 0.15). Twenty‐four‐hour esophageal pH monitoring data showed the mean reflux index was significantly lower in the children treated with cisapride compared with controls (five trials, weighted mean difference −6.24; 95% CI −8.81 to −3.67). With cisapride treatment, there was no reduction in the mean number of reflux episodes lasting greater than 5 min (three trials, weighted mean difference −0.72; 95% CI −1.92 to 0.47) or in the number of children with esophagitis at final follow up compared with baseline (two trials, relative risk 0.80; 95% CI 0.40 to 1.61). There was no significant difference in reported side‐effects or adverse events (six trials, relative risk 1.16; 95% CI 0.95 to 1.41).

Conclusions  No clinically important benefits of cisapride in children with gastroesophageal reflux have been demonstrated. Nor was there any evidence of adverse or harmful events.
Camphor toxicity
Authors: Emery DP , Corban JG
Published: March 2003

Camphor ingestion led to status epilepticus in a 20‐month‐old girl who required intubation and ventilation. She was treated with intravenous valium and phenobarbitone, and nasogastric activated charcoal. She made a complete neurological recovery. A number of products containing a high concentration of camphor were found to be available in the local community.
The diagnosis of Prader–Willi syndrome
Authors: Smith A
Published: March 2003

Abstract: The methylation test can make the diagnosis of Prader–Willi syndrome (PWS) in approximately 99% of patients and is confirmed as a reliable, robust screening test. In a patient with PWS, methylation analysis does not provide the mechanism, for which other different genetic tests are required. Appropriate tests are available in each Australian state.
True hermaphroditism
Authors: Walker AM , Walker JL , Adams S , Shi E , McGlynn M , Verge CF
Published: March 2003

Objective: True hermaphroditism is a rare cause of atypical genitalia which presents significant diagnostic and management challenges. We present the clinical and laboratory findings and management of four patients with true hermaphroditism.

Methodology: Case studies from a teaching hospital and literature review.

Results: All four patients had atypical genitalia identified at birth. All had a palpable gonad, only one of which was palpable at birth. Three patients were 46XX (SRY – ve) and one 46XY (SRY + ve). Three patients were raised as females (two 46XX and one 46XY) and one as a male. All four patients were found to have an ovotestis present.

Conclusions: The management of true hermaphroditism is controversial and requires a multidisciplinary approach. It has many implications for both the parent and child. We discuss the issues involved for the patients and their parents.
A follow‐up pilot study of objective measures in children with attention deficit hyperactivity disorder
Authors: Aggarwal A , Lillystone D
Published: March 2003

Objectives: Attention deficit hyperactivity disorder (ADHD) is a common childhood problem requiring stimulant medications in a significant proportion of cases. The aim of this pilot study was to assess the effects of prolonged stimulant medication therapy on a continuous performance test, the Test of Variables of Attention (TOVA), which measures objectively features of ADHD.

Methods: Eighteen children aged 8 to 16 years who were diagnosed with ADHD, based on the Diagnostic and Statistical Manual of Mental Disorders 4th edn criteria, were included in the study. Assessment on a continuous performance test (TOVA) was performed initially and the children were administered stimulant medications for at least 12 months. The medications were stopped for 1 week, followed by a repeat TOVA assessment which was compared to the initial TOVA assessment.

Results: Follow up TOVA scores showed a significant improvement in mean commission errors (impulsivity) after the stimulant medication therapy. No significant improvement was found in omission errors (inattention), response time and variability. There was a significant positive correlation between commission and omission scores (Pvalue 0.0001).

Conclusions: The results of this pilot study indicate that there is objective improvement in impulsivity in children with ADHD after a prolonged period of stimulant medication therapy. The study suggests that it would be useful to perform formal studies to investigate this further and also to assess the role of continuous performance test (TOVA) as a method for monitoring the need for ongoing therapy.
Congenital and neonatal varicella in Australia
Authors: Forrest JM , Mego S , Burgess MA
Published: March 2003

Objective: To establish the incidence and severity of congenital and neonatal varicella in Australia.

Methodology: Demographic and clinical details were obtained by postal questionnaire regarding cases notified to the Australian Paediatric Surveillance Unit by over 930 participating clinicians in 1995–97 inclusive.

Results: Seven cases of congenital varicella (1 : 107 000 pregnancies/year) followed maternal infection at 8–26 weeks: five had defects, two did not. Four of the seven infants with congenital varicella developed herpes zoster in the first 15 months of life. Forty‐four infants had neonatal varicella (1 : 17 000 pregnancies/year).

Conclusion: There is an ongoing, albeit low, incidence of congenital and neonatal varicella in Australia.
Diffuse neonatal haemangiomatosis
Authors: Ho V W G , Krol A , Bhargava R , Osiovich H
Published: March 2003

Abstract: A newborn girl with severe diffuse neonatal haemangiomatosis is described. She was treated with high dose systemic corticosteroids and high dose interferon‐alpha‐2a, but with fatal outcome. A review of the current literature is presented.
Central nervous system candidiasis in preterm infants: Limited value of biochemical markers for diagnosis
Authors: Ng Pc , Lee Ch , Fok Tf , Chui K , Wong W , Cheung Kl , So Kw
Published: March 2003

Abstract: Two rare cases of isolated central nervous system (CNS) candidiasis in preterm infants have been diagnosed in a tertiary neonatal centre over the past 6 years. Despite the life‐threatening nature of the disease, biochemical infection markers were not useful for the early identification of localized fungal infection. Because the infection was likely to have been blood borne, we postulated that the initial fungal load was probably low and that the organisms were rapidly eliminated from the circulation after a few had been deposited in the CNS. Hence, the absence of fungaemia or systemic involvement precluded the activation of cytokines and cellular markers. Clinicians should be aware of the limitation of biochemical infection markers so that diagnosis and treatment of fungal infection will not be delayed.
Trends in the specialist workforce in paediatrics in Australia, 1981–1997
Authors: Goulston Kj , Dent Of
Published: March 2003

Objective: The Royal Australasian College of Physicians has conducted periodic workforce censuses of Fellows practising paediatric medicine in Australia since 1981. The aim of this study was to document trends in the supply of paediatricians and to project these trends into the early 21st century.

Methodology: Time series analysis using least squares regression.

Results: The paediatric consultant workforce in Australia increased in a linear manner from 374 in 1981 to 777 in 1997. If this trend persists, the number of paediatricians will grow by 62% to 1255 in 2016. The ratio of population aged 0–14 years per paediatrician fell from 9960:1 in 1981 to 5040:1 in 1997. The projected national decline in the child population will result in a ratio of 3050 children per paediatrician in the year 2016. The proportion of women in the paediatric workforce was 22.4% in 1997 and is projected to rise to at least 36% by 2016. The proportion aged 50 years and older rose from 22% in 1981 to 33.6% in 1997 and is projected to be 45% by the year 2016. The average total weekly working hours fell from 58.2 in 1984 to 53.4 in 1997. The proportion practising in regional centres rose from 12 to 17.9%.

Conclusions: The paediatric workforce in Australia has grown rapidly over the past 16 years. If this trend continues, the ratio of child population per paediatrician will continue to fall, acccentuated by the projected decline in the child population. The trends towards an ageing workforce with an increasing proportion of women, declining working hours and rising proportion practising in regional centres are expected to continue unless workforce intake or retirement change dramatically.
Ataxia with isolated vitamin E deficiency: A clinical, biochemical and genetic diagnosis
Authors: Alex G , Oliver Mr , Collins Kj
Published: March 2003

Abstract: A case of ataxia with isolated vitamin E deficiency, in conjunction with supportive genetic studies, is reported. This is a neurodegenerative condition that involves a mutation in the tocopherol (α) transfer protein gene (TTPA). Measurement of serum vitamin E concentration should be included as part of the investigations in children with progressive ataxia, even in the absence of fat malabsorption. Early treatment with vitamin E may protect such patients against further neurological damage.
Sudden infant death syndrome in South Australia 1968–97. Part 3: Is bed sharing safe for infants?
Authors: Beal S M , Byard R W
Published: March 2003

Objective: To examine the risk of death for bed‐sharing infants.

Methodology: All unexpected infant deaths occurring in South Australia between 1970 and 1997, occurring after the infant was put to rest and diagnosed by after death scene investigation and autopsy as sudden death infant syndrome, accidental death, or ‘undetermined’ were studied.

Results: Accidents were the most likely cause of death for 5% of infants who died in designated infant containers (cots, cradles, etc), 24% of those who were sharing a bed or couch, and 72% of those who were placed alone on a bed or couch.

Conclusions: While bed sharing showed an increased risk of dying accidentally, when compared with infants sleeping in designated infant containers, the risk of accidental death in this study was even greater for infants left alone on adult beds or couches.