bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastroallergic anisakiasis: Findings in 22 patients
Authors: López‐Serrano Maria Concepción , Gomez Alicia Alonso , Daschner Alvaro , Moreno‐Ancillo Alvaro , De Parga José M Suarez , Caballero Maria Teresa , Barranco Pilar , Cabañas Rosario
Published: March 2003

Background and Aims
: Ingestion of Anisakidae larvae in raw seafood may cause anisakiasis. However, despite the high level of consumption of seafood in Spain, only a few cases of anisakiasis have been reported until now. Anisakis simplex can cause allergic reactions in sensitized patients as a result of its parasitism in the gastrointestinal tract. The purpose of this study was to analyse the clinical findings in 22 patients with gastroallergic anisakiasis.

Methods
: Patients with allergic and/or gastric symptoms after seafood ingestion were evaluated in the emergency room of the La Paz General University Hospital. Skin testing for Anisakis simplex and tests on the implicated seafood were performed and amounts of serum‐specific immunoglobulin E were assessed. A gastroscopy was performed in those patients with severe allergic or/and persistent gastric symptoms after ingestion of raw or undercooked seafood.

Results
: Twenty‐two patients were diagnosed with gastroallergic anisakiasis in 1 year. Most patients presented to the emergency room of our hospital with allergic symptoms. Gastric symptoms were usually moderate. Gastroscopy revealed local mucosal oedema and gastric erosion at the point of fixation. Two or more worms were detected in three patients. The mean time of latency of allergic symptoms was 5 h, while the mean time for gastric symptoms was 3 h.

Conclusion
: Anisakis simplex parasitism was the causative agent of allergic and gastric symptoms. Gastroallergic anisakiasis appears to be a relatively common disease, that may have been underdiagnosed.
Clinical and haemodynamic aspects of hepatopulmonary syndrome in Indian patients with cirrhosis
Authors: De Binay K , Sen Sambit , Biswas Pranab K , Biswas Jayanta , Maity Ajit K
Published: March 2003

Background
: Hepatopulmonary syndrome consists of the triad of hepatic dysfunction and/or portal hypertension, intrapulmonary vascular dilatation and hypoxaemia, in the absence of detectable primary cardiopulmonary diseases. In the present study, we examined the frequency of hepatopulmonary syndrome among Indian patients with cirrhosis, and studied clinical predictors and pulmonary haemodynamic alterations.

Methods
: Forty‐five patients with cirrhosis and no cardiopulmonary diseases were investigated by air‐contrast echocardiography. Where patients were positive, arterial blood gas analysis was carried out. Positive contrast echocardiography with Po2 < 70 mmHg confirmed the diagnosis of hepatopulmonary syndrome. Three cases with the syndrome and 24 without were assessed for haemodynamic status by hepatic and pulmonary catheterization.

Results
: Four of 45 cases of cirrhosis (8.9%) had positive contrast echocardiographies, including three (6.7%) with hepatopulmonary syndrome and one ‘subclinical’ case (positive contrast echocardiography without hypoxaemia). Under haemodynamic study, the mean pulmonary arterial and pulmonary capillary wedge pressures appeared to be lower among those patients with hepatopulmonary syndrome.

Conclusions
: In this small study, the frequency of hepatopulmonary syndrome was relatively low (6.7%). Cyanosis was the only reliable clinical indicator, and there was no clear relationship with the severity of cirrhosis by Child’s grading.
Low incidence of hepatitis C virus transmission between spouses: A prospective study
Authors: Kao Jia‐Horng , Liu Chun‐Jen , Chen Pei‐Jer , Chen Wendy , Lai Ming‐Yang , Chen Ding‐Shinn
Published: March 2003

Background
: Interspousal transmission of hepatitis C virus (HCV) has been documented; however, the annual risk of interspousal transmission remains unclear.

Methods
: A long‐term prospective study to define the risk of interspousal transmission of HCV was conducted. One hundred and twelve index patients with chronic hepatitis C and their anti‐HCV seronegative spouses were enrolled.

Results
: The mean follow‐up period was 45.9 months. Antibodies to HCV (anti‐HCV) and HCV‐RNA were tested for in each seronegative spouse every year. Seroconversion of anti‐HCV occurred in only one spouse, 2 years after enrolment, with a concomitant acute hepatitis. This subject and his spouse were infected with HCV genotype 1b. Nucleotide sequence comparison of the hypervariable region of their HCV genomes showed a homology of 98%. Further phylogenetic analysis suggested that they had virtually the same isolate. Accordingly, the annual risk of interspousal transmission of HCV infection was 0.23% per year.

Conclusions
: These findings suggest a low incidence of interspousal transmission of HCV; however, the risk may be cumulative and such couples should be educated to avoid HCV infection from their spouses.
Enhancement of poly‐adenosine diphosphate‐ribosylation in human hepatocellular carcinoma
Authors: Nomura Fumio , Yaguchi Masae , Togawa Akira , Miyazaki Masaru , Isobe Kazumasa , Miyake Masami , Noda Masatoshi , Nakai Toshiaki
Published: March 2003

Background
: Poly‐adenosine diphosphate (ADP)‐ribosylation, catalysed by poly(ADP‐ribose) polymerase (PARP), is a post‐translational modification of nuclear proteins and is involved in a wide range of biological processes including DNA repair, cell proliferation and malignant transformation. Alteration of this reaction in human hepatocellular carcinoma (HCC) is of interest, but has not yet been explored. The aim of this study was to evaluate poly‐ADP‐ribosylation and to compare the expression of PARP in HCC and adjacent non‐tumour tissues.

Methods
: Tumorous and adjacent non‐tumorous tissues were obtained from five consecutive patients with HCC during surgery for tumour resection. Tissue homogenates were subjected to ADP‐ribosylation with [32P]‐nicotinamide adenine dinucleotide. The ADP‐ribosylated proteins were separated by sodium dodecylsulfate–polyacrylamide gel electrophoresis, followed by autoradiography. Expression of PARP was also evaluated by western blotting.

Results
: Several proteins were ADP‐ribosylated in human HCC tissues. Notably, the radiolabelling of a 116‐kDa protein was remarkably greater than that in adjacent non‐tumorous tissues (86.5 ± 35.2 arbitrary units by densitometry vs 12.2 ± 9.9, mean± SD, n = 5, P < 0.02). The radiolabelling of the 116‐kDa protein was decreased in the presence of PARP inhibitors in a concentration‐dependent manner. Immunoblot analyses revealed that the radiolabelled protein was PARP and that its expression was significantly greater in HCC than in adjacent non‐tumorous tissues (333 ± 204% of non‐tumorous tissue, P < 0.05).

Conclusions
: We found that poly‐ADP‐ribosylation and PARP expression were significantly increased in human HCC compared with those in adjacent non‐tumorous tissues in surgically obtained specimens.
Reprocessing of flexible endoscopes
Authors: Leung Joseph W
Published: March 2003

Abstract Proper reprocessing of endoscopes prevents the risk of transmission of infection between patients. Meticulous mechanical cleaning is the most important step as it removes the majority of the contaminating bacteria. It should be performed before manual or automatic disinfection. High‐level disinfection involves total immersion of the endoscope in a liquid chemical germicide (LCG) at a preset temperature and concentration for a pre‐determined period of time. Subsequent rinsing and drying are essential steps to remove the chemical solution and prevent bacterial colonization during storage. Endoscopy units that are used for more than 50 procedures per week may benefit from cleaning in an automatic endoscope reprocessor (AER). This allows automated exposure of the endoscope to the LCG with subsequent flushing and drying of the channels, and minimizes staff exposure to the LCG. Reprocessing should be performed by trained and accredited personnel according to written guidelines or standards of practice as defined by professional societies. Regular monitoring of the reprocessing process is important for quality control and in ensuring patients' safety.
Clinicopathologic analysis of stage II–III hepatocellular carcinoma showing early massive recurrence after liver resection
Authors: Yamanaka Junichi , Yamanaka Naoki , Nakasho Keiji , Tanaka Tsuneo , Ando Tatsuya , Yasui Chiaki , Kuroda Nobukazu , Takata Masafumi , Maeda Shigeto , Matsushita Kazuyuki , Uematsu Kunio , Okamoto Eizo
Published: March 2003

Abstract Background and Aims: Prognosis after hepatectomy for hepatocellular carcinoma (HCC) has been improved by progress in the evaluation of hepatic functional reserve, surgical techniques and perioperative management. However, even when curative resection is performed at a relatively early stage, a considerable number of patients develop early intrahepatic and/or extrahepatic recurrence postoperatively. This study analyzed the clinicopathologic features of HCC with early recurrence.

Methods: We reviewed records of 513 consecutive patients who had undergone liver resection for HCC. There were 48 deaths within a year after surgery from recurrence, including 21 patients with stage II or III HCC (group I). Clinicopathologic parameters of group I patients were compared with those of 188 patients (group II) who developed recurrence following resection of stage II or III HCC and died more than 1 year after surgery.

Results: On univariate analysis, age, tumor diameter (Φ), α‐fetoprotein (AFP):Φ and protein induced by vitamin K absence or antagonist II (PIVKA‐II):Φ were significantly greater in group I than in group II. Macroscopic portal vein invasion, microscopic vascular invasion, intrahepatic metastasis, poor differentiation, pleomorphism, sarcomatous change, vascular lake, and angiographic condensed pooling were more frequently observed in group I than group II. Five independent determinants were selected by multivariate analysis: AFP:Φ, histologic pleomorphism, sarcomatous change, vascular lake and angiographic condensed pooling.

Conclusions: Highly malignant HCC with extremely poor prognosis exhibits peculiar clinicopathologic characteristics, particularly histologic immaturity, and can be predicted by preoperative indicators such as markedly elevated tumor marker concentrations and condensed pooling on angiography.
Immunohistochemical localization of vascular endothelial growth factor in the rat portal hypertensive gastropathy
Authors: Tsugawa Kouji , Hashizume Makoto , Tomikawa Morimasa , Migou Shinichirou , Kawanaka Hirofumi , Shiraishi Sachiko , Sueishi Katsuo , Sugimachi Keizo
Published: March 2003

Background and Aims: Portal hypertensive gastropathy (PHG) is now recognized to be a distinct entity. Recently, angiogenesis has been noticed as a key factor in clarifying the pathophysiology of various diseases. Angiogenesis in the PHT of explored gastric mucosa has yet to be explored. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor. The aim of the present study was thus to investigate whether the hypoxic state exists in PHG, and whether VEGF appears more strongly in PHG than in normal gastric mucosa and, if so, what exactly is the role of the hypoxic state and VEGF in PHG.

Methods: At 1, 3, 7 and 14 days after either a portal ligation or sham operation, the portal venous pressure, the gastric mucosal blood flow volume and the blood gas were measured and, the expression of VEGF and antiproliferating cell nuclear antigen (PCNA) in gastric mucosal specimens was immunohistochemically assessed.

Results: The portal pressure (PP) and the gastric mucosal blood flow (GMBF) in the PHT rats were significantly greater than in the control (CTR). Both the SaO2 and PaO2 of the arterial blood gas were lower in the PHT rats than in the control rats. The percentage of VEGF expression in the PHG was found to be higher than that in the control gastric mucosa. The percentage of PCNA expression in the PHG was higher than that in the control gastric mucosa.

Conclusion: The levels of SaO2 and PaO2 were lower in the PHT rats. There is a possibility that a kind of portal hypertensive gastric change may trigger an enhanced histochemical expression of VEGF. The increased activity of VEGF may have a possibility of the hypoxic gastric mucosal state caused by the presence of active congestion. This damaged mucosal state ‘PHG’ may thus facilitate the fragility in PHG and such lesions may be slow and insidious, which may therefore lead to sudden and severe anemia, thus causing massive and sometimes fatal hemorrhaging.
Medium‐chain fatty acids stimulate interleukin‐8 production in Caco‐2 cells with different mechanisms from long‐chain fatty acids1
Authors: Tanaka Seigou , Saitoh Osamu , Tabata Kazue , Matsuse Ryoichi , Kojima Keishi , Sugi Kazunori , Nakagawa Ken , Kayazawa Masanobu , Teranishi Tsutomu , Uchida Kazuo , Hirata Ichiro , Katsu Ken‐Ichi
Published: March 2003

Background and Aim: It has been suggested that dietary fat exacerbates intestinal inflammation. We investigated the effect of fatty acids on interleukin (IL)‐8 production in a human intestinal epithelial cell line (Caco‐2).

Methods: The cells were cultured as monolayers on microporous membranes in culture inserts. Oleic acid (OA), capric acid (CA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were applied to the apical compartment of Caco‐2 cell monolayers. The concentration of IL‐8 in the basolateral medium was measured by using enzyme‐linked immunosorbent assay, and the expression of IL‐8 mRNA was measured by using competitive reverse transcription–polymerase chain reaction. Protein kinase C inhibitors (GF109203X and calphostin C) and H‐7 (a protein kinase inhibitor) were used to study the mechanisms by which IL‐8 production is stimulated.

Results: Both OA and CA enhanced IL‐8 production (approximately fivefold), whereas DHA and EPA did not. Both OA and CA also enhanced IL‐1‐induced IL‐8 production. The onset of OA‐induced IL‐8 production was delayed compared with that of CA‐induced IL‐8 production. Both OA and CA enhanced IL‐8 mRNA expression (approximately fivefold) after 6 and 3 h, respectively. The protein kinase inhibitor (H‐7) reduced both OA‐ and CA‐induced IL‐8 production by 88.0 and 85.9%, respectively. The protein kinase C inhibitors (GF109203X and calphostin C) reduced OA‐induced IL‐8 production by 29.3 and 54.5%, respectively, but showed no effect on CA‐induced IL‐8 production.

Conclusions: These findings suggest that not only OA but also CA stimulates IL‐8 production in intestinal epithelial cells, and the mechanisms of action differ between OA and CA.
Increased risk of antituberculosis drug‐induced hepatotoxicity in individuals with glutathione S‐transferase M1 ‘null’ mutation
Authors: Roy Bidyut , Chowdhury Abhijit , Kundu Somnath , Santra Amal , Dey Badal , Chakraborty Madan , Majumder Partha P
Published: March 2003

Background: Pathogenesis and genetic factors influencing predisposition to antituberculosis drug (ATD)‐induced hepatotoxicity are not clear. Polymorphism at the genetic locus of a drug and xenobiotic compound metabolizing enzyme, N‐acetyltransferase type 2 (NAT2), is reported to be associated with the excess generation of toxic reactive metabolites. Polymorphisms at the glutathione S‐transferase (GST) loci (GSTM1 and GSTT1) are involved in the detoxification of these toxic metabolites in the human body to a lesser extent. We have examined whether polymorphisms at these loci are associated with the risk of ATD‐induced hepatotoxicity.

Methods: In this case‐control study, 33 pulmonary tuberculosis patients with ATD‐induced hepatotoxicity and 33 pulmonary tuberculosis patients receiving ATD drugs without any evidence of hepatotoxicity were considered as cases and controls, respectively. Point mutations at NAT2 and homozygous ‘null’ mutations at GSTM1 and GSTT1 genes were looked into genomic DNA, isolated from peripheral blood mononuclear cells by using polymerase chain reaction (PCR).

Results: The frequency of homozygous ‘null’ mutation at the GSTM1 gene was significantly higher among cases (n = 17, 52%) than controls (n = 8, 24%) (P < 0.05, relative risk 2.13, 95% CI: 1.25–3.10). Frequencies of mutations at GSTT1 and NAT2 genes did not differ significantly between cases and controls.

Conclusion: Homozygous ‘null’ mutation at the GSTM1 gene might predispose an individual to ATD‐induced hepatotoxicity.
Multicenter prospective analysis of newly diagnosed hepatocellular carcinoma with respect to the percentage of Lens culinaris agglutinin‐reactive α‐fetoprotein1
Authors: Oka Hiroko , Saito Akiko , Ito Kazuki , Kumada Takashi , Satomura Shinji , Kasugai Hiroshi , Osaki Yukio , Seki Toshihito , Kudo Masatoshi , Tanaka Masatoshi
Published: March 2003

Background and Aim: The Lens culinaris agglutinin‐reactive fraction of α‐fetoprotein (AFP‐L3) has been reported to be a highly useful marker for hepatocellular carcinoma (HCC) compared with a conventional serum AFP concentration, which allows earlier detection of HCC compared with using other imaging modalities and predicting prognosis after therapy. A collaborative prospective study involving nine Japanese hospitals was conducted to analyze the relationships between the tumor characteristics of a HCC patient and the percentage of AFP‐L3/AFP total at the initial detection.

Methods: Between 1 October 1996 and 30 September 1997, a total of 388 patients with newly diagnosed HCC were registered.

Results: The cut‐off level of the percentage of AFP‐L3 was altered from 15 to 10%. The AFP‐L3‐positive HCC patients demonstrated the characteristics of having an advanced tumor, such as the number of tumors, maximum diameter, tumor spread, portal vein invasion, tumor stage, and tumor classification. With the conventional cut‐off level of 15% of the percentage of AFP‐L3, the malignant characteristics were more definite than that of 10%. However, no significant differences of serum AFP concentration were observed for malignant characteristics such as maximum diameter and histopathological grading.

Conclusion: Serum AFP concentration does not reveal a malignancy of HCC, however, the AFP‐L3‐positive HCC has biologically malignant characteristics, especially portal vein invasion and lower tumor classification, and is an advanced tumor regardless of small tumor size and lower serum AFP concentration. As AFP‐L3 shows the tumor characteristics, its presence should be an important factor in the determination of therapy and prognosis of patients.
Case–control study of calcification of the hepatic artery in chronic hemodialysis patients: Comparison with the abdominal aorta and splenic artery
Authors: OKUDA KUNIO , KOBAYASHI SUSUMU , HAYASHI HARUYUKI , OHTAKE YOSHIO , NAKAJIMA KAZUAKI , YOSHIDA HIROMICHI , KASHIMA TAKASHI , IRIE YASUBUMI
Published: March 2003

Background and Aims: Studies of the hepatic artery are scarce. We have observed that hepatic artery calcification is very uncommon in patients with hyperparathyroidism that expedites calcification.

Methods: Plain abdominal CT was studied in 221 patients on chronic hemodialysis. Control consisted of 442 sex‐ and age‐matched patients with other diseases. Calcification was graded as a percentage of the entire wall circumference for the aorta, and as a percentage of the entire length of the hepatic and splenic arteries from the celiac trunk to the hilum of each organ.

Results: Aortic calcification was seen in 79.2% of male dialysis patients, 22.1%

of controls, 74.1% of female dialysis patients and 17.3% of controls

(P < 0.0001). Hepatic artery calcification was seen in only 13 dialysis

patients. The degree of calcification of the abdominal aorta was correlated with

the length of hemodialysis period (P = 0.008), but not with serum calcium, serum phosphate or their product. Although serum parathormone levels were not correlated with calcification, seven of eight dialysis patients with hepatic artery calcification had very high parathormone levels.

Conclusions: The hepatic artery is far less frequently calcified than are the abdominal aorta and splenic artery. This may be a teleologic phenomenon of the liver.
Changing disease burden and management issues for esophageal cancer in the Asia–Pacific region
Authors: Law Simon , Wong John
Published: March 2003

Abstract  The changing epidemiology of esophageal cancer in developed countries is from squamous cell type to adenocarcinomas arising from Barrett’s epithelium and the gastric cardia. This has implications for management of this disease. Earlier diagnosis of cancer from screening high‐risk patients with Barrett’s esophagus is potentially possible, and mucosal ablation together with acid‐suppressive therapies have been investigated to revert Barrett’s epithelium in its premalignant stage. When a cancer has developed, the strategies of staging methodology and surgical approaches also differ from those applicable for squamous cell cancers located in more proximal locations of the esophagus. By contrast, in the Asia–Pacific region (with the exceptions of Australia and New Zealand), squamous cell cancers in the middle portion of the esophagus remain the main cell type seen. An overall increase in life expectancy has led to more elderly patients presenting with carcinoma of the esophagus. This is of particular importance when surgical resection is contemplated. Advances in surgical management, multimodality programs, and endoscopic therapies are most marked in recent years. Treatment for patients with esophageal cancer should be individualized. The choice depends on expertise and facilities available, tumor and patient factors , and local economics.

© 2002 Blackwell Publishing Asia Pty Ltd
Hepatitis C in childhood
Authors: Hardikar Winita
Published: March 2003

Abstract  The approach of a pediatric hepatologist in managing children with hepatitis C virus (HCV) differs from adult practice, because the pediatric hepatologist is dealing with the beginning of a chronic illness in which long‐term outcomes will not occur for 20 or 40 years, and it is not possible to predict in the early stages of the infection which patients have a more sinister prognosis. The prevalence of chronic HCV in children is low, but varies between different countries in the Asia–Pacific region. In most countries, screening of blood products for HCV has virtually eliminated the risk of post‐transfusion HCV, so that in Australia children aged less than 11 years will not have acquired HCV from blood transfusion or extracorporeal membrane oxygenation. The risk of perinatal transmission of this virus is only about 6%, but this remains virtually the only source of HCV transmission for children in most countries. While available data are limited, mild histological changes are present in the majority of children with hepatitis C, and cirrhosis is rare. Unfortunately, long‐term natural history studies of the course of HCV infection in children have not been reported. Individual decisions on antiviral treatment are more difficult in childhood, not because the treatment is any less effective or because of the severity of side‐effects (which tend to be less severe than for adults), but because the long‐term outcome of infection is unclear. At present, treatment should be confined to those with significant hepatic fibrosis and continued moderate to severe necroinflammatory change. Measures to prevent HCV infection in childhood center on whether, as recently suggested, elective cesarean section may reduce the risk of transmission. Despite the presence of HCV‐RNA in some breast milk samples, there is no evidence that breast‐feeding confers any risk of HCV infection.

© 2002 Blackwell Publishing Asia Pty Ltd
Chronic pancreatitis: Asia–Pacific consensus report
Authors: Tandon Rakesh Kumar , Sato Nobuhiro , Garg Pramod Kumar ,   The Consensus Study Group
Published: March 2003

Abstract Current knowledge about chronic pancreatitis (CP) is limited and there is a particular dearth of information about the entity known as tropical pancreatitis. A consensus working party was convened by the Trustees of theJournal of Gastroenterology and HepatologyFoundation to conduct a systematic investigation into available evidence about the epidemiology, etiopathogenesis, diagnosis and management of CP. A literature search and formal survey of international experts in the field were used to assemble reliable evidence about these issues. The present review summarizes the results of the working party’s findings and presents a series of practice guidelines to improve diagnosis, investigation and treatment of patients with CP, particularly those in the Asia–Pacific region. Areas for further research have also been identified.

© 2002 Blackwell Publishing Asia Pty Ltd
Pyogenic liver abscess: Retrospective analysis of 80 cases over a 10‐year period
Authors: Wong Wai‐Man , Wong Benjamin Chun Yu , Hui Chee Kin , Ng Matthew , Lai Kam Chuen , Tso Wai Kuen , Lam Shiu Kum , Lai Ching Lung
Published: March 2003

Background: A total of 80 patients with pyogenic liver abscess managed at a single institution over a 10‐year period were studied.

Methods: The clinical features, laboratory, imaging, and microbiologic findings, management strategy, and final outcome were studied.

Results: Fever and chills, leucocytosis and elevated alkaline phosphatase were the most common clinical and laboratory findings. Forty‐one percent of patients were diabetic and 61% had biliary pathology. Systemic antibiotics and image‐guided aspiration had a success rate of 94%. By multiple logistic regression analysis, malignancy on presentation (P = 0.011) was an independent risk factor associated with mortality. A past history of endoscopic sphincterotomy was an independent factor associated with resolution of liver abscess within 6 weeks (P = 0.03).

Conclusion: Pyrexia, leucocytosis, elevated alkaline phosphatase, presence of diabetes, and underlying biliary pathology are common clinical and laboratory findings in patients with pyogenic liver abscess. Malignancy was associated with a poor outcome. Previous endoscopic sphincterotomy was a good prognostic factor for early resolution.

© 2002 Blackwell Publishing Asia Pty Ltd
Role of cyclooxygenase‐2 and inducible nitric oxide synthase in pancreatic cancer
Authors: Kong Gu , Kim Eun Kyung , Kim Wan Sup , Lee Kyu Taek , Lee Yong Wook , Lee Jong Kyun , Paik Seung Woon , Rhee Jong Chul
Published: March 2003

Abstract Background and Aim: Recently, it has been recognized that both cyclooxygenase‐2 (COX‐2) and inducible nitric oxide synthase (iNOS) produce important endogenous factors of human tumor progression. However, the clinicopathological and biological significance of the expression of COX‐2 and iNOS in pancreatic cancer remains unclear. The objective of this study is to find the possible roles and clinical significance of COX‐2 and iNOS expression in pancreatic cancer.

Methods: Seventy‐two pancreatic adenocarcinoma tissue specimens were obtained through surgical resection. We investigated the immunohistochemical expression of COX‐2 and iNOS in respect to variable clinicopathological characteristics, proliferation activity (by Ki‐67 expression), apoptosis (by terminal deoxyribonucleotidyl transferase‐mediated dUTP nick‐end labeling stain), and microvessel density (by CD34 expression; angiogenesis).

Results: Immunohistochemical investigations demonstrated immunolabeling of tumor cells with the primary antibodies, bovine anti‐iNOS and anti‐COX‐2 antibodies. The COX‐2 and iNOS positive rates were 41.7 and 66.7%, respectively. There was significant correlation between positive COX‐2 and positive iNOS expression (P
= 0.043). The proliferation index (Ki‐67 labeling index) was higher in COX‐2 positive specimens compared to COX‐2 negative specimen (P
= 0.015). The apoptotic index of positive iNOS expressions was significantly higher than negative expressions (P < 0.001). The expression of COX‐2 and iNOS proteins did not correlate with age, sex, serum bilirubin, CA‐19–9, location, size, American Joint Committee on Cancer stage, differentiation, distant metastasis, patient survival, or microvessel density.

Conclusions: Although the pattern of positive expression was similar in both enzymes, the effect on tumor progression differed; iNOS expression may play a role in apoptosis of tumor cell, while COX‐2 expression may contribute to tumor proliferation. However, COX‐2 and iNOS expression is not related to prognosis in patients with pancreatic cancer.

© 2002 Blackwell Publishing Asia Pty Ltd
Cyclooxygenase‐2 mRNA is up‐regulated in cirrhotic or chronic hepatitis liver adjacent to hepatocellular carcinoma
Authors: Morinaga Soichiro , Yamamoto Yuji , Noguchi Yoshikazu , Imada Toshio , Rino Yasushi , Akaike Makoto , Sugimasa Yukio , Takemiya Shoji , Kameda Yoichi , Takanashi Yoshinori
Published: March 2003

Background and Aim: Hepatocellular carcinoma (HCC) is unique in that its carcinogenesis is related to inflammatory changes and regenerative activities in the background liver. Although there are some data on cyclooxygenase (COX)‐2 expression in HCC by immunohistochemical studies, little is known about the possible role of COX‐2 in inducing hepatitis and/or carcinoma. To elucidate whether COX‐2 is involved in a part of these processes, we attempted to examine COX‐2 mRNA both in the adjacent non‐tumoral liver and in HCC.

Methods: Twenty‐two matched sets of adjacent liver and HCC specimens were analyzed for COX‐2 mRNA expression using a real‐time quantitative reverse transcription polymerase chain reaction. Cyclooxygenase‐2 protein expression was also determined by immunohistochemistry.

Results: Cyclooxygenase‐2 mRNA expression was significantly higher in the adjacent liver than in HCC (P = 0.016). Cyclooxygenase‐2 mRNA expression in adjacent liver tissues was positively correlated with the modified histological activity index scores (r = 0.575, P = 0.006), the serum alanine aminotransferase levels (r = 0.536, P = 0.010), and the Ki‐67 labeling indices (r = 0.698, P = 0.001). In contrast, COX‐2 mRNA expression in HCC was not correlated with any of the clinicopathological features.

Conclusions: Cyclooxygenase‐2 is expressed at higher levels in the adjacent liver than in HCC, and it may be associated with high levels of necroinflammation and regeneration in the background liver. Conversely, COX‐2 may have a lesser role in the progression of HCC.
Role of the longitudinal smooth muscle coat in the ileal motile activity: Evidence of ileo–ileal inhibitory reflex
Authors: SHAFIK AHMED , SHAFIK ALI A , AHMED ISMAIL
Published: March 2003

Background
: All gut movements are claimed to be activated essentially by the concentric contraction of the circular muscle, moving the chyme aborally. The role of the longitudinal smooth muscle of the small intestine in gut motility is poorly understood; this point was investigated in the current study.

Methods
: The abdomens of 14 crossbreed dogs (eight dogs, six bitches) were opened. A segment of the small intestine was distended by a balloon in increments of 2 mL of saline, and the pressure and electrical activity were recorded proximally and distally to the balloon. The gut wall around the balloon was anesthetized and the test was repeated. The longitudinal muscle coat of the small intestine segment was then excised, and the pressure response and electrical activity were recorded on ileal distension.

Results
: Two milliliter ileal distension produced pressure decrease (P < 0.05) proximally and distally to the balloon and caused balloon movement. Four, 6 and 8 mL distension effected similar pressure response, while 10 mL showed no response. Electrical waves were recorded from the three electrodes applied to the ileal segment. Upon ileal distension, electrical activity increased over the distended area, with no activity proximally and distally to it. Balloon distension of the anesthetized ileal segment produced no pressure response or electrical activity. After longitudinal myectomy, no electrical activity was recorded at rest or upon ileal distension, and the balloon did not move.

Conclusion
: Ileal distension initiated circular muscle contraction only in the presence of the overlying longitudinal muscle, which appears to transmit the electrical activity to the circular muscle upon ileal distension. Ileal contraction is suggested to initiate ileal hypotonia in the proximal and distal ileal segments mediated through an ‘ileo–ileal inhibitory reflex’ that leads to aboral progress of the proximally and distally located chyme.

© 2002 Blackwell Publishing Asia Pty Ltd
Lower esophagus in dyspeptic Iranian patients: A prospective study
Authors: NASSERI‐MOGHADDAM SIAVOSH , MALEKZADEH REZA , Sotoudeh MASOUD , TAVANGAR MOHAMMAD , AZIMI KOUROSH , SOHRABPOUR AMIR‐ALI , MOSTADJABI PARDIS , FATHI HOSNIEH , MINAPOOR MINA
Published: March 2003

Background: Gastroesophageal junction cancer has increased over time in Western countries. Gastroesophageal reflux disease (GERD) is considered to be a major risk factor. We prospectively studied the prevalence of clinical, histological and endoscopic GERD, and premalignant changes among dyspeptic Iranian patients referred for upper gastrointestinal endoscopy (UGIE).

Methods: Consenting patients referred for UGIE to our clinic were enrolled. Their symptoms were recorded, UGIE was conducted, and biopsies from all suspicious lesions and across the Z‐line were taken.

Results: Of the 344 enrolled patients, 269 (135 women, 134 men; mean age: 41.6 years) were evaluated. One major GERD symptom (heart burn, acid regurgitation, dysphagia and chest pain) was seen in 209 (77.6%) patients, and 207 patients (76.1%) had endoscopic esophagitis. Thirteen patients (5%) had specialized intestinal metaplasia at the gastrointestinal junction (SIM‐GEJ), and three had glandular dysplasia (two low‐grade, one high‐grade). No symptom could predict the presence of histological or endoscopic findings. Patients with dysplasia had more advanced degrees of endoscopic esophagitis.

Conclusion: Gastroesophageal reflux disease is common among Iranian patients referred for diagnostic endoscopy. The prevalence of SIM‐GEJ among this population was comparable to that reported in Western countries.
Intra‐abdominal manifestations of Henoch‐Schönlein Purpura
Authors: CHOONG CK , BEASLEY SW
Published: March 2003

Gastrointestinal involvement occurs in approximately two thirds of children with Henoch‐Schönlein Purpura (HSP) and usually is manifested by abdominal pain. Abdominal symptoms precede the typical purpuric rash of HSP in 14–36%; the symptoms may mimic an acute surgical abdomen and result in unnecessary laparotomy. Major complications of abdominal involvement develop in 4.6% (range 1.3–13.6%), of which intussusception is by far the most common. The intussusceptum is confined to the small bowel in 58%; its frequent inaccessibility to demonstration by contrast enema means that ultrasonography is the investigation of choice. Ultrasonography complements serial clinical assessment, clarifies the nature of the gastrointestinal involvement and reduces the likelihood of unnecessary surgery. Bowel ischaemia and infarction, intestinal perforation, fistula formation, late ileal stricture, acute appendicitis, massive upper gastrointestinal haemorrhage, pancreatitis, hydrops of the gallbladder and pseudomembranous colitis are seen infrequently. Earlier diagnosis and prompt treatment of intra‐abdominal complications has reduced the mortality from 40% to almost zero.
Is breast feeding in bed always a safe practice?
Authors: BYARD RW
Published: March 2003

Objectives:

To examine whether infants who are being breast fed in their mother’s bed are at increased risk of accidental suffocation.

Materials and methods:

Review of all cases of unexpected infant death occurring in South Australia, Australia during 1996 was undertaken to ascertain whether any cases of sudden infant death had occurred in association with breast feeding in the parental bed. All infants had death scene examinations, history reviews and full autopsies performed.

Results:

Three of a total of 28 cases of unexpected infant death were identified where accidental asphyxia associated with breast feeding‐related cosleeping was considered a likely cause of death. Maternal fatigue was a factor in each of the three cases. There were nine SIDS cases and 16 other cases which included non‐accidental injury, accidental asphyxia, congenital cardiovascular disease and sepsis.

Conclusions:

Accidental asphyxia is a rare but possible outcome if mothers fall asleep in bed with their infants while breast feeding. Nursing mothers should be made aware of the potential dangers of fatigue and sedation in such circumstances. Breast feeding out of bed, or in the company of a second person who can ensure the safety of the infant if breast feeding is occurring in bed may prevent these unfortunate fatalities.
A novel approach to monitoring adherence to preventive therapy for tuberculosis in adolescence
Authors: Starr M , Sawyer SM , Carlin JB , Powell CVE , Newman RG , Johnson PDR
Published: March 2003

Objectives: To evaluate the usefulness of a microelectronic tablet‐dispenser for monitoring adherence to preventive therapy for tuberculosis infection in adolescents.

Methodology: Twenty‐one patients with positive Mantoux tests were treated with isoniazid (INH), dispensed in a microelectronic tablet‐dispenser that recorded the date, time and duration that the container was opened. Other measures of adherence included attendance at clinic, patient self‐report, tablet count, and measurement of urinary INH metabolites.

Results: The mean adherence rates were: 83% using attendance at clinic, 91% using tablet counts, 79% using urine assays, and 66% using the electronic tablet‐dispenser. Self‐reporting appeared to over‐estimate adherence.

Conclusions: Adherence to 6 months of INH calculated using different measures is higher in this study than in previous reports. Microelectronic tablet‐dispensers are an effective method to objectively measure adherence on a daily basis. Other measures are less helpful.
A quality assurance review of outpatient care of children with life‐threatening asthma exacerbations
Authors: Dakin CJ , Wales S , Field P , Henry R , Morton J
Published: March 2003

Objectives: A hospital admission for asthma represents an opportunity to address and improve asthma control. The aims of this study were to compare the ambulatory care of children admitted to the intensive care unit (ICU) following a life‐threatening asthma exacerbation with published guidelines of asthma management and to identify areas that could be targeted for change.

Methods: A retrospective review of case notes of children admitted to the ICU with asthma over a 6‐month period. Variables recorded were: demographic; asthma history (including prior pattern of asthma, hospital admissions, interval treatment and managing doctor); admission details (consultation of respiratory team and asthma educator); and discharge management.

Results: There were 40 admissions of 38 children (24 males) with mean age 5.7 years (range 1.1–14 years). The majority (58%) had previous admissions for asthma (55 admissions in 22 children), with 23% of these to ICU. Sixty three per cent of those with previous admissions had persistent asthma, but only 29% were on inhaled corticosteroid (ICS). Most (60%) were managed by their local medical officer (LMO). Use of ICS was more likely if managed by a paediatrician. A respiratory subspecialist was consulted in 42% and the asthma educator in 70% of ICU admissions. Discharge medication included ICS in 74%, with no interval treatment in 18% of admissions. Follow up was by a respiratory subspecialist in 25% of cases.

Conclusion: Asthma management before and after admission with life‐threatening asthma did not conform to available guidelines. Persistent asthma was under‐treated. Paediatricians were more likely to use interval treatment than LMO. We identified areas in which quality of care and outcome could be improved in this vulnerable group of asthmatics.
Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention
Authors: Grattan‐Smith P J , Ryan M M , Procopis P G
Published: March 2003

Background: Children with severe or persistent back pain and stiffness often have an underlying organic cause but there is a large differential diagnosis, examination may be difficult and the problem is relatively rare in general paediatric practice. These difficulties appeared to lead to delays in diagnosis and management of children with this problem.

Objectives: To provide an approach to the diagnosis and management children with severe or persistent back pain or stiffness based on our clinical experience and the literature.

Methodology: The case histories of 10 children with severe back pain seen by the authors over a 5‐year period were reviewed. They were chosen as illustrative examples of the diagnostic and management problems and did not represent a systematic review of all cases seen by the authors over that time.

Results: Underlying causes included infection, inflammation, neoplasm, trauma and vascular malformation. Four of the children had spinal cord compression which required urgent decompression. There was one child with a conversion disorder but three children with organic disease were initially felt to have a conversion disorder. Investigations generally proceeded relatively slowly and the problem was not regarded as a semi‐urgent situation carrying the risk of permanent paraplegia. Magnetic resonance imaging (MRI) scan of the spine was the investigation of choice.

Conclusion: Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.
The drug epidemic: Effects on newborn infants and health resource consumption at a tertiary perinatal centre
Authors: Kelly J J , Davis P G , Henschke P N
Published: March 2003

Objectives: Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre.

Methodology: An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women’s Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital’s obstetric database.

Results: Ninety‐six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty‐three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01).

Conclusions: Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources.
A 7‐year review of deaths on the general paediatric wards at John Hunter Children’s Hospital, 1991–97
Authors: Mallinson J , Jones P D
Published: March 2003

Objective: To study the palliative management of children dying on the wards of a tertiary referral centre. In particular to identify areas of difficulty and discuss ways in which these can be improved.

Methodology: All children between the ages 1 and 19 years dying on the general paediatric wards of the John Hunter Children’s Hospital (JHCH) (a tertiary referral centre in New South Wales Hunter Valley) between 1991 and 1998 were included in the study. The main outcome measures were the duration of ‘terminal care only’ treatment; time spent in hospital in the previous year; analgesia used, dose and route of administration; adjuvant medications; quality of life in the final 24 h.

Results: Eighteen children (aged between 1 and 19 years) died on the general paediatric wards at JHCH between 1991 and 1998. The most common diagnosis was malignancy (five patients), with cystic fibrosis, cerebral palsy and a degenerative neurological disorder each accounting for four patients, and one child had herpes simplex encephalitis. In all children the terminal nature of their condition was recognized and in all but three patients there was documentation of ‘not for resuscitation’ (NFR) orders following discussion with the child’s parents. The mainstay of analgesia was an intravenous narcotic infusion with 11 (61%) children needing a morphine infusion. Fifteen patients (83%) required other medications including antiemetics, anticonvulsants and corticosteroids. Twelve (66%) children were semiconscious or unconscious on the day of death. Three children were uncomfortable and distressed, one alert and symptom free and in two cases the level of consciousness was not recorded. Three children continued to have seizures until their death.

Conclusion: The majority of terminally ill children were managed well with intravenous narcotics and adjuvant medications. There may be scope for such children to be managed successfully at home with appropriate support for the general practitioner by paediatric and palliative care specialists. Some cases in which palliation is difficult do remain in hospital and additional measures need to be employed to ensure a symptom free death for these children.
Prevalence and pattern of childhood abdominal pain in an Australian general practice
Authors: Huang Rc , Palmer Lj , Forbes Da
Published: March 2003

Objective: Abdominal pain is a common problem in childhood and accounts for a significant workload in general practice. The aim of this study was assess the nature of abdominal pain in a sample of Australian children attending a Western Australian general practice for any reason, and to determine factors associated with the reporting of such pain.

Methodology: A prospective study of children and their families attending a rural general practice was undertaken using a parental survey to assess the frequency and nature of abdominal pain, demographic features, physical and behavioural characteristics.

Results: Abdominal pain was common in this population; 44% (70 of 164) of parents reported that the index child had experienced abdominal pain in the past 12 months. The average age of children who experienced recent abdominal pain was 9 years and 9 months. Multivariate analysis suggested that children experiencing abdominal pain in the preceding 12 months were more likely to be anxious (odds ratio (OR) = 3.74,P= 0.01), to have a family history of similar problems in siblings (OR = 4.26,P= 0.01) and to experience sleep disturbance (OR = 3.90,P= 0.02) than children without abdominal pain. Consumption of three or more serves of wholemeal bread or cereals per day had a significant protective effect on reported abdominal pain in children (OR = 0.12,P= 0.03). The majority of families (66%) dealt with the pain without resorting to medical care.

Conclusions: Abdominal pain remains a common problem of children attending an Australian general practice, and was associated with features suggesting that it is related to anxiety and coping ability. Abdominal pain is not usually associated with disease; most families recognize this and cope with abdominal pain without medical consultation.