bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterogeneous distribution of microcirculatory disturbance in the gastric mucosa during gastric hypercontraction in rats
Authors: TANI KAZUHIRO , YAMAGUCHI TAKASHI , KUBOTA YOSHITSUGU , FUJIMURA KAZUYO , MIZUNO TAKAKO , INOUE KYOICHI
Published: March 2008

Gastric mucosal lesions induced by gastric hypermotility are characteristically observed along the gastric mucosal folds. To determine the role of microcirculatory disturbance in this particular condition, we measured the gastric mucosal haemodynamics after vagal stimulation and also examined histologically the transparent specimens of the transverse section of the contracted stomach in rats. Gastric mucosal haemodynamics measured with a reflectance spectrophotometer showed the repetition of ischaemia‐reperfusion during gastric hypermotility. The rapidly frozen and transparent specimen of the corpus showed that gastric mucosa was stretched at the crest and compressed at the base of the mucosal folds. Characteristic distribution of red blood cells was observed; it was dense at the crest of the mucosal folds and sparse at the base. These results suggest that gastric hypermotility may induce the distinctive heterogeneous microcirculatory disturbance in the folds and may contribute to the characteristic localization of mucosal lesions.
Involvement of N‐acetyl‐lactosamine‐containing sugar structures in the liver metastasis of mouse colon carcinoma (colon 26) cells
Authors: KAWAKAMI HAYATO , ITO MASATAKA , MIURA YUKI , HIRANO HIROSHI
Published: March 2008

Histochemical aspects of the process of experimentally induced metastasis were examined by light and electron microscopy with labelled lectins employed as a probe. Mouse colon carcinoma cells (colon 26) were injected into the spleen of Balb/c mice and liver metastasis was induced. Among the lectins tested, Erythrina cristagalli agglutinin (ECA) stained the metastasized colon 26 cells strongly compared with the heterogeneous and faint staining in non‐metastasized tumour foci in the spleen or in the subcutaneous space. Other lectins, such as Phaseolus vulgaris ieucoagglutinin (PHA‐L), Phaseolus vulgaris erythroagglutinin (PHA‐E) and Datura stramonium agglutinin (DSA), having specificity for branched complex type sugar chains, did not show any differences between metastasized cells and non‐metastasized tumour foci. In addition, N‐acetyl‐lactosamine, a specific inhibitor of ECA binding, significantly inhibited the attachment of suspended colon 26 cells to sectioned unfixed normal liver tissue. These results indicate that the expression of galactose (Gal) β 1–4 N‐acetyl‐glucosamine (GlcNAc) residues of branched complex type sugar chains having specificity for ECA are important for the interaction process of carcinoma cells with hepatic cells in the process of liver metastasis.
Clinical features in young adult patients with ischaemic colitis
Authors: MATSUMOTO TAKAYUKI , IIDA MITSUO , KIMURA YUTAKA , NANBU TAKUMI , FUJISHIMA MASATOSHI
Published: March 2008

The clinical, radiographic and endoscopic findings in 16 patients with ischaemic colitis, all of whom were <45 years of age, were analysed. The clinical features were characterized by an acute onset of abdominal pain and rectal bleeding, and persistent constipation prior to the onset of symptoms. Twelve of the 16 patients did not have any known predisposing factors. Barium enema examination and colonoscopy revealed longitudinal ulcers and oedema of the left side of the colon of these patients. These features were then compared with those found in patients with ischaemic colitis, who were > 70 years of age. Although the clinical symptoms, the site of involvement and the initial radiographic or endoscopic findings were similar between the two groups, the transient form of ischaemic colitis and constipation prior to the onset of symptoms were more frequently present in the young patients than in the old patients. These findings suggest that ischaemic colitis, which is not a rare condition even in young adults, is less severe in young patients than in old patients, and that constipation may be related to the pathogenesis of this disease in young adults.
Enteroglucagon, but not CCK, plays an important role in pancreatic hyperplasia after proximal small bowel resection
Authors: SASAKI MASAYA , BAMBA TADAO , HOSADA SHIRO
Published: March 2008

The present study was performed to examine the role played by pancreatotrophic factors, especially enteroglucagon and cholecystokinin (CCK), in the compensatory pancreatic hyperplasia observed after proximal small bowel resection (PSBR). Male Wistar rats were randomized into two groups, receiving either PSBR or transection (TRC). Five animals from each group were randomly selected for treatment with FK‐480, a novel CCK antagonist. Four weeks after the operation, plasma levels of gastrin, CCK and enteroglucagon were measured. Pancreatic wet weight and protein, DNA, RNA and enzyme content were also determined. The wet weight and content of protein, DNA and RNA were significantly higher in PSBR rats than in TRC rats, regardless of whether they received FK‐480. FK‐480 had no suppressive effects on adaptive pancreatic growth after PSBR. Plasma enteroglucagon levels rose significantly in PSBR rats, and there were positive correlations between plasma enteroglucagon levels and pancreatic protein, DNA and RNA content. These findings demonstrated that plasma CCK was not the major trophic factor operating in the pancreas after PSBR, and showed that enteroglucagon plays an important role in the pancreatic hyperplasia that occurs after PSBR.
An early gallstone clearance following repeat piezoelectric lithotripsy
Authors: TSUCHIYA YUKIHIRO , TAKANASHI HIDEKI , HANIYA KAZUO , NISHIARAI HIROMI , MIKAMI SIGERU , NATSUKI YUTAKA , KUNIYUKI HIROSHI , SAITO HIROBUMI , SAITO NOBUHIKO , OHTO MASAO
Published: March 2008

Piezoelectric extracorporeal litotripsy was performed in 128 symptomatic patients with radiolucent gall‐bladder stones to assess the significance of disintegration in fragment clearance. Up to 10 repeat lithotripsy sessions were scheduled to achieve a fragment target size of <3 mm. Fragmentation assessed by the size of the largest fragments after the last session was graded into three classes. I: sludge‐like disintegration, 18%; II: <3 mm (mean ± s.d., 1.7 ± 0.5 mm), 56%; and III: < 3 mm (3.3 ± 0.6), 26%. All patients were initially subjected to lithotripsy alone. Bile acid dissolution therapy was started only when ultrasonography failed to show the evidence of decrease in the <3 mm fragments during a 1 month follow up. Finally, 69 patients (54%) were treated by lithotripsy alone, and the remaining 59 received additional dissolution therapy at a mean period of 2.5 months after the initial lithotripsy. The rate of complete clearance in class I, II and III patients was 91, 42 and 10% at 6 months and 100, 68 and 49% at 18 months, respectively. Significant differences were noted between the three fragmentation grades (I vs II, III, P <0.0001; II vs III, P <0.02). The patients with complete clearance within 6 months were seen only in those treated by lithotripsy alone, while the majority (87%) of patients with complete clearance during the later period were seen in those treated by additional dissolution therapy.

We conclude that a high degree of fragmentation appears to lead stones to an earlier period clearance, and reduce the need for dissolution therapy.
Effect of hepatocyte volume on energy status in the cirrhotic rat liver
Authors: MATSUI Y. , OKUDA Y. , NAKAGAWA M. , KWON A‐H. , MINOURA T. , HIRAMATSU Y. , UETSUJI S. , KAMIYAMA Y.
Published: March 2008

To evaluate the effect of reduced hepatocyte volume on liver energy status, the relationship between the morphologically quantified hepatocyte volume and biochemical parameters, and the difference in nuclear density between the parenchyma and stroma were assessed in rat livers with thioacetamide‐induced cirrhosis. The ratio of hepatocytes to whole liver tissue, defined as the ‘hepatocyte area ratio', and the nuclear densities of the parenchyma and stroma were calculated microscopically with an image analysing system. Adenine nucleotide, protein and DNA contents, and the ornithine carbamoyltransferase activity in the liver were assayed. In the cirrhotic group, adenine nucleotide content, protein content and ornithine carbamoyltransferase activity were positively correlated with the hepatocyte area ratio, whereas DNA content was negatively correlated with this ratio. The adenylate energy charge of the cirrhotic liver was maintained at a constant level regardless of the ratio. Adenine nucleotide content, protein content and ornithine carbamoyltransferase activity per fractional ‘hepatocyte area ratio’ in cirrhotic livers were significantly lower than in control livers. The nuclear density of the stroma was significantly greater than that of the parenchyma. These results suggest that the lowered energy status in the cirrhotic liver is not caused by reduced hepatocyte volume but rather by impaired hepatocyte metabolism. In addition, the morphological measurement with an image analysing system was found to be useful for evaluating the effects of decreased hepatocyte volume on biochemical derangements in cirrhotic tissue.
An estimation of human bile metastability: Clinical application of a sensitive cholesterol crystal growth assay
Authors: OHYA TOSHIHIDE , TAZUMA SUSUMU , HATSUSHIKA SUMIE , TERAMEN KAZUSHI , AIHARA NAOKI , SASAKI MASATOSHI , YAMASHITA YOSHIFUMI , OCHI HIDENORI , HORIKAWA KAZUHIKO , MIURA HIROYUKI , HIRANO NAOMICHI , KAJIYAMA GORO
Published: March 2008

The formation of cholesterol monohydrate crystal initiates cholesterol gallstone formation. The nucleation time (NT), a light microscopy method, is used currently to estimate human bile metastability. Recently, a cholesterol crystal growth (CCG) assay utilizing photometric turbidity to quantitate cholesterol crystallization was developed using model bile systems. The object of this study was to determine whether this novel CCG assay was applicable to the quantitative assessment of native human bile metastability. Human gall‐bladder bile samples were collected from patients undergoing cholecystectomy. There were five patients with cholesterol gallstone and five stone‐free patients. A significant correlation between the onset time measured by the CCG assay and the NT observed by light microscopy was found in our modified assay condition where interference by bilirubin was negligible (P < 0.01). Also, the growth rate measured by the CCG assay significantly correlated with the NT (P < 0.05). These results indicate that the CCG assay is applicable to quantitative assessment of human bile metastability reflected by cholesterol crystal nucleation and that the cholesterol crystal growth is also conveniently estimated by this method.
Reovirus serotype 3 infection in infants with extrahepatic biliary atresia or neonatal hepatitis
Authors: RICHARDSON SIMONE C. , BISHOP RUTH F. , SMITH ARNOLD L.
Published: March 2008

Infection with reovirus serotype 3 (reo 3) has been postulated to be associated with extrahepatic biliary atresia (EHBA) in infants, and with neonatal hepatitis (NNH). We have investigated this association by assaying antireo 3 antibodies in sera from infants (aged < 4 months) with EHBA (n= 40), NNH (59), cholestatic liver disease due to other causes (61) and control infants with no liver disease (138). Antireo 3 immunoglobulins (Ig) of the G, A and M classes were measured by enzyme‐linked immunosorbent assay. No differences in the prevalence of antireo 3 IgG or IgA were found between any of the four groups. A significantly higher prevalence of positive antireo 3 IgM was found in infants with EHBA (12/40), NNH (12/59) or cholestatic liver disease associated with parenteral nutrition (7/17), alpha‐1 antitrypsin deficiency (4/15) or a variety of other causes (15/29) compared with control infants (13/138). These data support an association between reovirus 3 infection and cholestatic liver disease in infants. The nature of this association may differ for EHBA, NNH and cholestatic liver disease due to other causes, and remains to be determined.
Peptic ulcer disease in the elderly in Singapore
Authors: NG T. M. , FOCK K. M. , CHIA S. C. , CHEW C. N. , CHONG Y. Y. , CHEE E. N. , YAP C. K.
Published: March 2008

Of 460 patients with peptic ulcer disease seen over a 30‐month period, there were 174 elderly patients (defined as ? 60 years old), constituting 38%. In this group of elderly, gastric ulcers (GU) were observed more frequently than duodenal ulcers (DU) with a ratio of 1.6: 1 and the male to female ratio was 1.7: 1. In patients < 60 years old, there were more DU than GU with a ratio of 2.7: 1, and a higher male to female ratio of 3.7: 1. Seventy‐two per cent of the elderly had at least one other medical condition with 20% having three or more medical problems. Hypertension and ischaemic heart disease were the most frequently encountered illnesses. Half the elderly presented with upper abdominal pain and one‐third had an atypical presentation. Analgesic ingestion in the preceding 4 weeks was present in 29% of the elderly. In the elderly, bleeding was the most frequent complication occurring in 50%; perforation occurred in 2%. In those with bleeding ulcers, 44% had history of analgesic usage. The mortality of bleeding peptic ulcer in the elderly, was 11% and this was largely due to concurrent medical conditions. Only two deaths occurred due to bleeding ulcer.
AIDS and the gut
Authors: CHUI DAVID W. , OWEN ROBERT L.
Published: March 2008

There are increasing challenges for the practising gastroenterologist in treating AIDS‐related gastrointestinal diseases. The differential diagnoses of dysphagia and odynophagia include cytomegalovirus (CMV) and herpes simplex virus (HSV) infection, non‐specific aphthous ulceration and non‐AIDS oesophageal diseases, especially reflux oesophagitis. Chronic subacute abdominal pain with nausea, vomiting, early satiety and weight loss is suggestive of an obstructive lesion caused by lymphoma or Kaposi's sarcoma. Severe acute abdominal pain can indicate pancreatitis or intestinal perforation due to cytomegalovirus. Right upper quadrant pain (with or without fever, vomiting or abnormal liver function tests with a cholestatic profile) is suggestive of hepatobiliary pathology including cholecystitis, cholangitis, acalculous cholecystitis and AIDS cholangiopathy. Diarrhoea is the most common gastrointestinal symptom of AIDS, affecting 50–90% of patients. Causes of AIDS diarrhoea include protozoa (Cryptosporidium parvum, Isospora belli, Enterocytozoon bieneusi, Septata intestinalis, Cyclospora spp, Entamoeba histolytica and Giardia lamblia), bacteria (Mycobacterium avium‐intracellulare, Clostridium difficile, Salmonella, Shigella and Campylobacter jejuni), and viruses (CMV, HSV and possibly HIV). Chronic diarrhoea, malnutrition and weight loss can shorten the life‐span of patients with AIDS. Elemental diets, isotonic formulas, medium chain triglycerides and total parenteral nutrition have been tried with little success in AIDS patients with severe diarrhoea and wasting.
Intestinal ischaemia associated with carcinoid tumour: A case report with review of the pathogenesis
Authors: BESSELL J. R. , KARATASSAS A. , ALLEN P. W.
Published: March 2008

A case of ischaemic ileal perforation associated with a macroscopically unapparent ileal carcinoid is described. The mesenteric vessels were non‐pulsatile at operation but were anatomically patent when examined by the pathologist. The characteristic elastic perivascular sclerosis of mesenteric vessels, which probably caused a functional vascular obstruction, was only discovered after the histological sections were reviewed. The true incidence of this rare condition may be higher than previously suspected because the perivascular sclerosis can easily be overlooked. Awareness of the association between carcinoid tumour and mesenteric ischaemia may lead to early surgery and an improved outcome.
Primary hepatic lymphoma in a patient with chronic hepatitis C
Authors: RYAN JEREMY , WALLACE SHARON , JONES PENELOPE , TAGGART GREG , DUDLEY FRANK
Published: March 2008

The case is presented of a woman with chronic active hepatitis C who developed primary hepatic lymphoma. The possible roles of viral hepatitis and therapeutic interferon in the pathogenesis and progression of this unusual maligancy are discussed. In addition, the importance of accurate tissue diagnosis to identify potentially treatable hepatic tumours is emphasized.
Intestinal passage of the PEG end‐piece: Is it safe?
Authors: COVENTRY BRENDON J. , KARATASSAS ALEX , GOWER LISA , WILSON PETER
Published: March 2008

Two rare but life‐threatening complications of percutaneous endoscopic gastrostomy (PEG) are reported: small bowel perforation and obstruction. Both resulted from impaction of the PEG end‐piece after separation at skin level. Review of the literature revealed very few complications from intestinal passage of PEG end‐pieces. The free intragastric PEG end‐piece routinely passes through the gastrointestinal tract in most cases. One of these two cases was drawn from a series of 100 patients with intentional intestinal passage of PEG end‐pieces to give a severe complication rate of 1%.

A case can be made for routine endoscopic per‐oral removal of PEG end‐pieces in the elective setting, but this is more costly and not without hazard. Previous laparotomy and/or known adhesions is a relative indication for endoscopic retrieval of the PEG end‐piece. Oesophageal disease or intolerance of endoscopy is a relative indication for intestinal passage. Close clinical follow up is recommended to ensure that the PEG end‐piece has passed per‐rectum. If the PEG end‐piece has not passed and is shown in the small bowel on plain X‐ray at ∼3 weeks after separation then lodgement has probably occurred and early operative intervention is warranted.
Levels of vitamin K, immunoreactive prothrombin, des‐γ‐carboxy prothrombin and γ‐glutamyl carboxylase activity in hepatocellular carcinoma tissue
Authors: YAMAGATA HIDEHARU , NAKANISHI TOSHIMI , FURUKAWA MIDORI , OKUDA HIROAKI , OBATA HIROSHI
Published: March 2008

Abstract To clarify the mechanism of production of des‐γ‐carboxy (abnormal) prothrombin (DCP) by hepatocellular carcinoma (HCC), we measured the levels of vitamin K, DCP, immunoreactive prothrombin and the activity of γ‐glutamyl carboxylase in liver tissues from HCC patients and in the medium of cultured human hepatoma cells. There was no significant difference in vitamin K (K1, MK‐4) contents between HCC and non‐HCC cirrhotic liver tissues. The activity of γ‐glutamyl carboxylase per unit amount of endogenous microsomal prothrombin precursor was decreased in HCC tissue compared with non‐HCC liver tissue (positive plasma DCP: 335 ± 72 vs 372 ± 67, negative plasma DCP: 370 ± 84 vs 393 ± 56 nmol/min per mg prothrombin precursor, P > 0.05), although the total incorporation of 14COOH into microsomal precursor protein was higher in the former. By contrast, levels of DCP and immunoreactive prothrombin in HCC tissue were greater (P > 0.05) than those in non‐HCC cirrhotic liver tissue. Furthermore, production of large amounts of immunoreactive prothrombin was observed in human hepatoma cells huH‐1 and huH‐2, which produced large amounts of DCP. These results suggest that there was excessive synthesis of prothrombin precursors by human HCC tissue and hepatoma cell lines huH‐1 and huH‐2. Thus, excessive synthesis of prothrombin precursors seems to be the main mechanism of DCP production by HCC.
Stepped care medical treatment for cirrhotic ascites: Analysis of factors influencing the response to treatment
Authors: TAKAYA AKIRA , FUKUI HIROSHI , MATSUMURA MASAHIKO , UEMURA MASAHITO , KOJIMA HIDEYUKI , OKAMOTO SHINGO , TSUJII TADASU
Published: March 2008

Abstract Thirty‐two patients with liver cirrhosis and ascites were treated by stepped care diuretic treatment as follows: step 1, placed on a 35 mEq sodium diet; step 2, given 400 mg/day of potassium canrenoate in addition to step 1 treatment; step 3, given 40‐80 mg/day of furosemide in addition to step 2 treatment. Eleven out of 32 patients (34.4%, group 1) and 12 of 21 patients (57.1%, group 2) lost their ascites at step 1 and step 2, respectively. The remaining nine patients (group 3) required step 3 treatment. Basal urinary sodium excretion and creatinine clearance were significantly lower and β2‐microglobulin was significantly higher in group 3 than those in groups 1 and 2. Elevation of basal plasma renin activity and norepinephrine was evident only in group 3. In group 1, urinary sodium excretion decreased after the treatment. In group 2, plasma α‐atrial natriuretic polypeptide was lowered and plasma renin activity and norepinephrine were elevated after the treatment. These results suggest that basal renal function and plasma renin activity and norepinephrine levels are useful indices to predict the effect of ascites treatment and that responders to sodium restriction or potassium canrenoate may be in the state of vascular overflow, while non‐responders to potassium canrenoate may be in the state of vascular underfilling. In summary, this stepped care treatment is safe without any side effects, although the diuretics themselves may lead to relative vascular underfilling.
Portal blood flow in acute hepatitis with and without ascites: A non‐invasive measurement using an ultrasonic Doppler
Authors: YANG SIEN‐SING , WU CHI‐HWA , CHEN TZEN‐KWAN , LEE CHIA‐LONG , LAI YUNG‐CHIH , CHEN DING‐SHINN
Published: March 2008

Abstract To evaluate the role of portal blood flow in severe acute hepatitis leading to the formation of ascites, we studied the portal blood flow of 30 patients with severe acute hepatitis (20 without ascites and 10 with ascites), 20 patients with mild acute hepatitis and 20 healthy normal volunteers using duplex sonography. The portal blood flow of patients with severe acute hepatitis and ascites (421 ± 94 mL/min) was lower than that of the volunteers (725 ± 131 mL/min), the mild acute hepatitis (658 ± 148 mL/min), and the severe acute hepatitis (633 ± 108mL/min) without ascites (P < 0.001). The congestion index of severe acute hepatitis and ascites (0.16 ± 0.04 cm · s) was higher than that of the volunteers (0.09 ± 0.03 cm · s, P < 0.001), the mild acute hepatitis (0.09 ± 0.02 cm · s, P < 0.001), and the severe acute hepatitis (0.12 ± 0.04 cm · s, P < 0.02) without ascites. Portal blood flow was negatively correlated with prolonged prothrombin time (P < 0.001) and serum total bilirubin level (P= 0.002) and congestion index was positively correlated with heart rate (P= 0.006), prolonged prothrombin time (P < 0.001). and serum total bilirubin level (P= 0.001). Our study shows that in severe acute hepatitis, portal blood flow was reduced in patients with ascites. The non‐invasive ultrasonic Doppler is a safe and helpful method in the clinical evaluation of portal hypertension in severe acute hepatitis.
Survival after a first episode of spontaneous bacterial peritonitis. Prognosis of potential candidates for orthotopic liver transplantation
Authors: ALTMAN CLAUDE , GRANGÉ JEAN‐DIDIER , AMIOT XAVIER , PELLETIER GILLES , LACAINE FRANÇOIS , BODIN FRANÇOIS , ETIENNE JEAN‐PIERRE
Published: March 2008

Abstract To determine the potential role of orthotopic liver transplantation (OLT) in cirrhotic patients surviving a first episode of spontaneous bacterial peritonitis (SBP), medical records of 79 patients presenting with a first episode of SBP were reviewed. Of these patients, 37 were selected as potential candidates for OLT using the following criteria: absence of hepatocellular carcinoma; no severe organ failure other than the liver; age ≤ 66 years; and survival after SBP > 60 days. Survival time was calculated from the day of SBP diagnosis. Prognostic value of clinical, biological and bacteriological data recorded at the time of SBP was determined using univariate and multivariate analysis (Cox's regression model).

Survival rate of the potential candidates for OLT at 3 months, 1 year and 2 years was 94, 46 and 30%, respectively. Serum creatinine value (P= 0.001) and Pugh score (P= 0.005) were independently correlated with death. The 1 year survival rate was 80% for the 11 patients with a Pugh score < 10, and 26% for the 26 patients with a Pugh score ≥ 10.

Our results suggest that after SBP, OLT should be considered in patients with severe liver disease. Survival of patients with a moderate liver disease (i.e. Pugh score < 10) might be relatively high.
Pre‐operative serum levels of tissue polypeptide antigen in patients with gastric cancer
Authors: HSIEH MAO‐CHIH , WU CHEW‐WUN , TSAY SHYH‐HAW , LUI WING‐YIU , P'ENG FANG‐KU
Published: March 2008

Abstract Pre‐operative serum tissue polypeptide antigen (TPA) levels were measured in cases of gastric cancer from December 1987 to December 1992. All 351 cases received gastrectomies. The clinicopathological factors were analysed. The significant factors that correlated with the elevation of pre‐operative serum TPA levels included tumour size (> 7 cm), Borrmann‐type cancers, late stages (III and IV), lymph node metastasis, hepatic metastasis and Ming's expanding type cancers. Multivariate analysis showed that the tumour size (> 7 cm) and the presence of hepatic metastasis are significant factors. To clarify the relationships between gastric cancer per se and the pre‐operative serum TPA levels, we selected cases without evidence of metastasis (n= 139). The tumour size was the only significant factor when multivariate analysis was applied. Possibilities of hepatic recurrence were found in cases with high pre‐operative serum TPA levels (> 220 U/L), even radical gastrectomies were performed. A high pre‐operative serum TPA level did not display a poor survival prognosis, if the radical gastrectomy was possible. We thus concluded that: (i) elevated pre‐operative serum levels of TPA are associated with either a large size tumour (> 7 cm) or the presence of hepatic metastasis and the tumour size is the most important factor relating to the serum TPA levels; (ii) high pre‐operative serum TPA levels (> 220 U/L) may serve as indicators of later hepatic recurrence; and (iii) elevated serum TPA levels were not indicators of survival prognosis.
Effects of loxoprofen sodium, a newly synthesized non‐steroidal anti‐inflammatory drug, and indomethacin on gastric mucosal haemodynamics in the human
Authors: KAWANO SUNAO , TSUJI SHINGO , HAYASHI NOBUHIKO , TAKEI YOSHIYUKI , NAGANO KOUICHI , FUSAMOTO HIDEYUKI , KAMADA TAKENOBU
Published: March 2008

Abstract Non‐steroidal anti‐inflammatory drugs (NSAID) are, and have been, frequently used for alleviation of pain in patients; however, they are known to cause gastric mucosal injury in experimental animals and in humans. A decrease in the gastric mucosal blood flow also plays an important role in the aetiology of acute gastric mucosal injury, as we previously reported. This study investigated the effect of a newly synthesized NSAID, loxoprofen sodium (sodium 2[p‐2 oxocyclopentylmethyl) phenyl]propionate dihydrate, on gastric mucosal haemodynamics using a reflectance spectrophotometry system. Both single and cross‐over methods were used in five volunteer subjects. Loxoprofen sodium 60 mg (one tablet) or indomethacin 25 mg (one tablet), was diluted in 10 mL water at 25°C and sprayed on the gastric mucosa via a polyethylene tube inserted into the biopsy channel of an endoscope. After drug administration, reflectance spectra were taken every 5 min for 30 min. The indices of mucosal haemoglobin content (IHb) and oxygen saturation of haemoglobin (ISO2) were determined by the method previously reported by the authors. Indomethacin administration produced a significant decrease in both IHb and ISO2 values, indication ischaemia. Loxoprofen sodium, however, showed no significant differences in either of the parameters. Haemorrhagic erosions were evident after indomethacin administration, but none were found after loxoprofen sodium administration. The conclusion reached on the basis of this evidence is that one‐time topical application of loxoprofen sodium is safer than indomethacin.
A clinical study on pseudomyxoma peritonei
Authors: HSIEH S. Y. , CHIU C. T. , SHEEN I. S. , LIN D. Y. , WU C. S.
Published: March 2008

Abstract To elucidate the clinical entity of pseudomyxoma peritonei, nine patients (male: female = 6:3) who had been treated in Chang Gung Memorial Hospital in the past 13 years were reviewed. The male patients with original appendiceal tumour were older than the male patients with original colon cancer or indefinite tumour (70, 67 and 67 years vs 42, 27 and 50 years). In addition, the former group survived in a disease‐free status for 28 months on average, while the latter group died within 2 years. Echogenic ascites and diffuse low‐attenuation intra‐abdominal masses with scalloping on the surface of liver detected by ultrasonography and by computerized tomography, respectively, were found in most of the patients. Elevation of the serum carcinoembryonic antigen (CEA) during recurrence of the disease was also noted. This series suggested that: (i) the pre‐operative diagnosis could be made with careful physical examination in conjunction with sonography or computerized tomography; (ii) the prognosis was better in patients with tumour of appendiceal origin; and (iii) serum CEA might be valuable for early detection of recurrence.
Prevention of duodenal ulcer relapse with omeprazole 20 mg daily: A randomized double‐blind, placebo‐controlled study
Authors: GOH K. L. , BOONYAPISIT S. , LAI K‐H. , CHANG R. , KANG J. Y. , LAM S. K.
Published: March 2008

Abstract We report the first double‐blind, placebo‐controlled study that assesses the efficacy and safety of omeprazole 20 mg daily in the maintenance treatment of duodenal ulcer. For the healing phase, 128 patients with endoscopically proven active duodenal ulcer and a history of three or more relapses during the 2 years prior to the study were treated until healing with omeprazole 40 mg daily for 2 and up to 8 weeks. One hundred and twenty‐three patients whose ulcers were healed were randomized to receive omeprazole 20 mg daily (n= 60) or placebo (n= 63) for 12 months as maintenance treatment. Patients were interviewed at 3, 6, 9 and 12 months, and endoscopy was performed at 3, 6 and 12 months and whenever symptoms recurred. The healing rates of the 124 patients completing the healing phase were 84, 98 and 100% at 2, 4 and 8 weeks, respectively. During the maintenance phase, eight and four patients discontinued treatment from the omeprazole and placebo groups, respectively. The proportion of patients in remission in the omeprazole group and placebo group after 12 months were 94 and 9% respectively (life table estimates, P < 0.0001). No significant clinical or laboratory changes were observed in patients on therapy with omeprazole. Patients with a history of frequent relapses thus continued to have a very high relapse rate without prophylactic treatment. Omeprazole 20 mg daily was effective and safe in maintaining such patients in remission.
Endoscopic ultrasonographic findings in rectal leiomyoma
Authors: TANAKA MUNEHIRO , FUJISHIMA HIROSHI , CHIJIIWA YOSHIHARU , NAWATA HAJIME , EGUCHI TORU , KINJO MITSURU
Published: March 2008

Abstract A 35 year old man visiting a hospital for his annual check‐up in August 1992 was found to have a large rectal tumour on digital examination. Colonoscopy revealed a bulging lesion with normal mucosa. Endoscopic biopsy showed only normal tissue. Endoscopic ultrasonography demonstrated a large hypo‐echoic submucosal tumour in the fourth layer (muscularis propria) of the rectal wall. Based on this endoscopic ultrasonographic finding, we diagnosed the tumour as leiomyoma pre‐operatively. The tumour was excised by a trans‐sacral local excision. The histological diagnosis of the resected specimen was cellular leiomyoma.
Acute Q fever hepatitis in Taiwan
Authors: WU CHENG‐SHYONG , CHANG KENG‐YUANG , LEE CHING‐SONG , CHEN TONG‐JONG
Published: March 2008

Abstract We report a case of a chronic hepatitis B carrier with an episode of acute hepatitis. The patient presented with a headache, arthralgias, jaundice and fever. While the laboratory tests mimicked chronic hepatitis B with an acute exacerbation, lipogranulomatous changes seen in the liver biopsy strongly suggested the presence of Q fever. Serology testing for Coxiella burneti proved positive and the patient responded to tetracycline therapy. While previously unreported in Taiwan, Q fever is important to consider in an atypical hepatitis presentation because it is a treatable condition.
Familial juvenile polyposis with adenomatous‐carcinomatous change
Authors: SHARMA A. K. , SHARMA S. S. , MATHUR P.
Published: March 2008

Abstract A family tree of 118 members with five members found to have juvenile polyposis‐adenomatous change and four juvenile polyposis‐adenomatous‐carcinomatous change is presented. All the patients developed bleeding per rectum between 10 and 17 years of age. Four members died of colonic malignancy between 30 and 55 years of age. Colonoscopy in five living members revealed typical juvenile polyps throughout the whole length of the colon and atypical large lobulated polyps containing adenomatous change in juvenile polyps in the rectosigmoid area. An autosomal dominant mode of transmission was evident on analysis of the pedigree. Gastric hyperplastic polyps were present in three of the five living members.

Familial juvenile polyposis may have the potential to progress into adenoma‐carcinoma sequence and is not always a benign disorder. Colonoscopic surveillance should be done to detect adenomatous change if any member of the juvenile polyposis family develops colonic malignancy.
Colonic mucosal antioxidant enzymes and lipid peroxide levels in normal subjects and patients with ulcerative colitis
Authors: BHASKAR LAKSHMI , RAMAKRISHNA B. S. , BALASUBRAMANIAN K. A.
Published: March 2008

Abstract Oxygen‐derived free radicals have been implicated in the pathogenesis of ulcerative colitis. Mammalian tissues contain antioxidant systems that offer protection from the damaging effect of these active species. In the present study, the activity of the antioxidant enzymes catalase, glutathione peroxidase, glutathione transferase and glutathione reductase were measured in rectal biopsies from patients with ulcerative colitis and compared with that obtained from normal subjects. A significant decrease in the activity of glutathione transferase was observed in ulcerative colitis (48.32 ± 6.73 units/mg protein, mean ± s.e.) compared to normal (68.20 ± 6.83; P= 0.015). There was no difference in the activity of other antioxidant enzymes between controls and ulcerative colitis. Myeloperoxidase, a marker for neutrophil infiltration, was considerably increased in ulcerative colitis while malonaldehyde, the end product of lipid peroxidation, was not increased. The reduced activity of glutathione transferase in ulcerative colitis may be an additional factor in the pathogenesis of mucosal damage in this disease.
Sulphated macromolecules produced by in vivo labelling in the rat gastric mucosa
Authors: LYONS K. C. , ANDREWS F. J. , COMPER W. D. , O'BRIEN P. E.
Published: March 2008

Abstract The aim of this study was to investigate the nature and distribution of sulphated macromolecules of the extracellular matrix in rat gastric mucosa. This was achieved by developing an in vivo labelling system.

An intraperitoneal injection of 1 mCi [35S]‐sulphate was given for either 4 h (0.01% incorporation into macromolecular fraction) or 8 h (0.13% incorporation). At the end of the labelling period the stomach was removed and the mucosa and submucosa was either taken as a single combined sample or separated into four layers by blunt dissection. Each sample was papain digested and analysed by ion‐exchange chromatography. This analysis revealed sulphated species of differing charge existing in differing proportions throughout the mucosa. These sulphated species eluted at NaCl concentrations of approximately 0 (A), 0.19 (B), 0.34 (C) and 0.78 mol/L (D) from a Q‐Sepharose ion exchange column. Further analysis by size exclusion chromatography and chemical and enzymatic digestion showed that peaks B and C had molecular weights of 2.4 × 105 and 2.8 × 105, respectively and were resistant to chondroitinase ABC, heparitinase and nitrous acid digestion. Peak D was found to contain a polydisperse population of molecules with a molecular weight range of approximately 1 × 104 to 6 × 104. This sample was susceptible to nitrous acid and chondroitinase ABC digestion and was found predominantly in the sample isolated from deeper in the tissue.

We have thus developed an in vivo labelling technique for sulphated macromolecules that can be used in the further study of injury to the gastric mucosa.
Immunoglobulin G subclass distribution of human anticolon antibodies in ulcerative colitis
Authors: OHARA M. , HIBI T. , WATANABE N. , KOBAYASHI K. , TAKAISHI H. , HAYASHI A. , HOSODA Y. , TODA K. , IWAO Y. , WATANABE M. , AISO S. , TSUCHIYA M. , ISHII H.
Published: March 2008

Abstract Immunoglobulin G (IgG) subclasses of anticolon antibodies were studied in patients with ulcerative colitis (UC) using enzyme‐linked immunosorbent assay (ELISA). The concentrations of total serum IgG subclasses were also measured by ELISA. The values for total serum IgG subclasses in patients with UC were not significantly different from those in normal controls, while the ratio of IgG1 to IgG2 in the patients was significantly higher than that in normal controls. All four IgG subclasses of autoantibodies were demonstrated in the sera of the patients. IgG4 anticolon antibodies were detected most frequently (15 out of 18 patients, 83%). IgG2 was the next most prevalent (9 of 18 patients, 50%). The activity of anticolon antibodies in each subclass did not correlate with the concentration of the corresponding serum IgG subclass. Seven cell lines producing anticolon antibodies were obtained from the colonic mucosa of the patients by Epstein‐Barr virus (EBV) transformation. IgG subclasses of anticolon antibodies secreted by these cell lines were also varied. IgG4 subclass was secreted by three EBV transformed cell lines, all of which produced IgG4 anticolon antibodies. These results suggest that all four different IgG subclasses could respond to the colon antigens and that various antigens in colonic mucosa or lumen may contribute to the induction of those autoantibodies. In addition, the prominence of IgG4 anticolon antibodies may support the pathogenic role of this subclass in UC as in other autoimmune diseases.
A non‐invasive method for evaluating cirrhotic portal hypertension by administration of 99mTc‐MIBI per rectum
Authors: WANG JI‐YAO , CHEN SHAO‐LIANG , CHEN FU‐ZHEN , XU WEI‐GANG , HU DE‐CHENG , CHEN XUE‐FEN , JIN GANG , LIU HOU‐YU
Published: March 2008

Abstract A study was performed to evaluate radio‐isotopic imaging using technetium‐99m hexakis 2‐meth‐oxyisobutyl isonitrile administered per rectum to assess portal collateral circulation.

The heart‐liver ratios (H/L; mean ± standard deviation) in 15 controls, 13 cases of histologically confirmed viral hepatitis and 57 cirrhosis patients were 0.27 ± 0.11, 0.43 ± 0.14 and 1.00 ± 0.28, respectively (P < 0.001). Among the cirrhosis patients those with the Child‐Pugh classification A, B and C had H/L of 0.56 ± 0.14, 1.00 ± 0.20 and 1.19 ± 0.26, respectively (P < 0.001). A high value of H/L was associated with a high risk of hepatic encephalopathy (1.25 ± 0.17, P < 0.01) and oesophageal varices (1.02 ± 0.20, P < 0.01). There were associations between H/L and serum bilirubin (P < 0.01), albumin (P < 0.05) and prothrombin time (P < 0.05). The results also showed a good correlation between H/L and portal vein pressure measured during operation in 13 patients (P < 0.001, r= 0.87). The regression equation: y= 6.77 + 32.5 H/L, allowed portal vein pressure to be estimated.

The prognostic value of the test was supported by the fact that good correlations were observed between the H/L ratio and widely accepted prognostic classification (Child‐Pugh). It is suggested that this new method could be a reliable non‐invasive way to give an indication of the degree of portasystemic shunting to evaluate the prognosis and to follow up the effects of medications for reducing portal hypertension in patients with cirrhotic portal hypertension.
Carbohydrate‐deficient transferrin in alcoholics with liver disease
Authors: CALDWELL STEPHEN H. , HALLIDAY JUNE W. , FLETCHER LINDA M. , KULAGA MARK , MURPHY THERESE L. , LI XUIMING , DICKSON ROLLAND C. , KIYASU PHILLIP K. , FEATHERSTON PATRICIA L. , SOSNOWSKI KENNETH
Published: March 2008

Abstract To assess the relationship between carbohydrate‐deficient transferrin (CDT) and alcoholic liver disease, we measured the ratio of carbohydrate‐deficient transferrin to total transferrin (rCDT) in 32 male alcoholics with liver disease (Child‐Pugh class A, 8; B, 11; C, 13) and 14 male alcoholics without clinically evident liver disease. Twenty of 32 with liver disease and six of 14 without clinically apparent liver disease had recent abstinence. The 32 patients with liver disease were assessed, in addition to the Child‐Pugh class, using a linear prognostic score, the Combined Clinical and Laboratory Index (CCLI). Transferrin and CDT were measured by isocratic anion exchange chromatography and a radio‐immunoassay. When the total group (n= 46) was divided into those with recent abstinence (n= 26) and those without (n= 20), the rCDT was lower in the abstainers than non‐abstainers (0.7 ± 0.6 vs 2.9 ± 2.4, P < 0.005). Similarly, abstainers with liver disease (n= 20) had a significantly lower rCDT than non‐abstainers (n= 12) with liver disease (0.7 ± 0.7 vs 3.5 ± 2.8, P < 0.005). The rCDT in the 20 abstaining patients with liver disease did not differ significantly between Child‐Pugh classes. Furthermore, there was no correlation between the CCLI and rCDT (r= 0.05). We conclude that the relationship between rCDT and alcohol abuse is not appreciably altered by the presence of clinically severe liver disease in male alcoholics.
Effects of nifedipine on hepatic venous pressure gradient and portal vein blood flow in patients with cirrhosis
Authors: OTA KAZUHIRO , SHIJO HIROSHI , KOKAWA HIROSHI , KUBARA KATSUHIKO , KIM TETSUHIRO , AKIYOSHI NOBUO , YOKOYAMA MASANORI , OKUMURA MAKOTO
Published: March 2008

Abstract We investigated the effects of nifedipine on splanchnic haemodynamics in 13 patients with cirrhosis and portal hypertension, and in 10 control subjects using hepatic venous catheterization and pulsed Doppler ultrasound. There were no significant changes in systemic or splanchnic haemodynamics in control patients. In contrast, systemic vascodilatation, evidenced by significant decreases in mean arterial pressure and systemic vascular resistance, was observed in patients 20 min after sublingual application of 10 mg nifedipine. Moreover, hepatic venous pressure gradient and portal vein blood flow significantly increased after nifedipine administration. There was a significant correlation between the percentage increases in portal vein blood flow and in hepatic venous pressure gradient. However, no correlation was found between the percentage change in cardiac output and that in portal vein blood flow. Thus the increase in portal vein blood flow appears to be related to splanchnic arterial vasodilatation by nifedipine. Consequently, nifedipine has deleterious effects on portal haemodynamics in patients with cirrhosis. As nifedipine may potentially increase the risk of variceal haemorrhage in patients with less advanced varices, this drug should be used with caution in patients with chronic liver disease.
Polarizing microscopy of partially dissolved gallstone powder: A simple technique for studying gallstone composition
Authors: CHOUDHURI G. , AGARWAL D. K. , NEGI T. S.
Published: March 2008

Abstract A quick and reliable method for estimating the proportion of constituents of a stone may be useful in determining the prevalence of chemical type of gallstones in different geographic areas or ethnic groups. Chemical and infrared spectroscopy estimation facilities are not commonly available in many parts of the world and visual inspection may not be reliable for scientific purposes. To investigate whether identification of microcrystalline solids in partially dissolved stone powder could accurately predict the chemical nature of the gallstone we undertook a blind study on 40 samples of gallstones and compared our results with those of visual inspection and quantitative infrared spectroscopy. There were 29 cholesterol stones (mean cholesterol 83.4 ± 7.5%), six intermediate cholesterol stones (mean cholesterol 48.0 ± 21.2%) and five pigment stones (mean cholesterol 14.3 ± 4.3%) as determined by quantitative infrared spectroscopy. Microscopic examination of partially dissolved gallstone powder in ethanol correctly identified all 29 cholesterol gallstones (sensitivity 100%, specificity 92%), four of six intermediate cholesterol stones (sensitivity 67%, specificity 100%) and all five pigment stones (sensitivity 100%, specificity 97%). It also detected microspheroliths of calcium carbonate in 14 of 16 calcium carbonate containing gallstones (sensitivity 88%, specificity 100%). The chemical grouping of stones on the basis of microscopic examination was correct in 37 (93%) of 40 samples and was especially useful in identifying ‘intermediate’ cholesterol stones which cannot be recognized by visual inspection. Thus microscopic examination of powdered gallstones appears to be a simple and reliable method of determining gallstone composition.
Clinical evaluation of titration of hepatitis C virus core antibody and its subclasses
Authors: TAURA YUKO , FUJIYAMA SHIGETOSHI , KAWANO SHIN‐ICHI , SATO SHINJIRO , TANAKA MOTOHIKO , GOTO MASAFUMI , CHIKAZAWA HIDETO , SHIBATA JUNJI , MIZUNO KYOSUKE , SATO TATSUO
Published: March 2008

Abstract Titrations of anti‐hepatitis C core (anti‐HCc) immunoglobulin G (IgG) antibodies and its subclasses were studied in 90 patients with acute and chronic hepatitis C virus (HCV) infection, including 27 patients who underwent interferon (IFN) therapy. The positivity rates for each anti‐HCc subclass were as follows: 95.2% for IgG1, 12.0% for IgG2, 69.9% for IgG3 and 19.3% for IgG4. The total anti‐HCc IgG titre correlated well with the IgG1 titre, indicating that IgG1 was the main virus‐specific IgG. Changes of IgG1 production mainly contributed to fluctuations of the anti‐HCc IgG titre and corresponded well to positivity for HCV‐RNA during and after IFN therapy. IgG3 was detected prior to IgG1 during the early phase of acute hepatitis in some cases and also appeared with relapse after IFN therapy. The serial assay of anti‐HCc subclasses showed the patients’ humoral immune response to HCV infection, and might be useful for evaluation of anti‐viral immunity influenced by IFN therapy.