bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic hepatitis with fatty change
Authors: ALVAREZ SOL Z. , BILLOTE JUANITO , ONGKINGCO‐OBILLOS CYNTHIA
Published: March 2008

Ten patients with clinical features of chronic hepatitis showed on liver biopsy histologic evidence of chronic hepatitis plus predominantly moderate to severe fatty change. No patient had a history of excess alcohol intake, or prolonged intake of hepatotoxic drugs and steroids, and were not obese or malnourished. These cases differ from the reported cases of non‐alcoholic steatohepatitis resembling alcoholic hepatitis as they occurred in relatively young healthy adults, predominantly males, who were not diabetic or obese. Mallory's hyalin in liver was absent in all cases. Ingestion of toxic substances was possible but no history was obtained to account for it. While these could be unusual cases of chronic non‐A, non‐B hepatitis, this can be only speculation until a serologic test for non‐A, non‐B hepatitis becomes available. Follow‐up of eight patients for 1–3 years with liver biopsy showed that they had a relatively benign course with no evidence of progression to cirrhosis.
Direct observation of the portal vein interior by intra‐operative angioscopy in the dog and man
Authors: YAMASHITA YUICHI , KIMITSUKI HIROSHI , HIRAKI MAMORU , KUROHIJI TOSHIHIKO , ISOMOTO HIROHARU , SAKAMOTO KAZUYOSHI , KAKEGAWA TERUO , OKUDA KUNIO
Published: March 2008

The purpose of this study was to develop the technique of intra‐operative portal angioscopy using a portal angioscope, and to demonstrate its potential use in the therapy for patients with hepatocellular carcinoma (HCC) bearing a portal thrombus. Portal angioscopes, Olympus BF3C10 and CHFP10 of a diameter of 3.5 mm and 4.8 mm, respectively, were used during operation in five dogs, two patients with hepatic metastasis from colon cancer and three patients with HCC having a portal tumour thrombus. The portal vein and hepatic artery were ligated simultaneously, and the angioscope was immediately introduced under direct vision through a small portal venotomy. Blood in the portal vein was almost fully diverted by infusion of heparinized saline through a channel of the angioscope at a rate of 3 mL/min in dogs and 5 mL/min in patients with hepatic metastasis. Rates of 6 mL/min and 10 mL/min in dogs and patients, respectively, were adequate to clear completely the portal vein of blood. In patients with HCC, portal tumour thrombectomy was performed with a Fogarty balloon catheter by suctioning thrombi through a channel of the fibrescope after visual study of the portal thrombus.

Observation and treatment of portal thrombus by angioscopy may become an important part of surgical treatment of HCC with portal invasion, but further technical improvement is desirable before this technique becomes a routine procedure.
Correlation of hepatitis B surface antigen clearance with the route of hepatitis B virus infection
Authors: TASSOPOULOS NICOLAOS C. , PAPAEVANGELOU GEORGE J.
Published: March 2008

We studied 563 consecutive adults with acute hepatitis B hospitalized from May 1981 to May 1983 and their habitual heterosexual partners. Radio‐immunoassays for the detection of serological markers of hepatitis A virus (HAV) and hepatitis B virus (HBV) and enzyme‐immunoassay for the detection of IgM antibody to hepatitis B core antigen (IgM anti‐HBc) were used. Of the 563 patients, 503 (89.7%) were hepatitis B surface antigen (HBsAg) positive and 60 (10.7%) were HBsAg negative on admission. Absence of HBsAg on admission was observed significantly more frequently in patients infected possibly by the heterosexual route than in the remaining patients (23.3% versus 6.6%; P < 0.001). This finding was independent of sex. These data show that the route of HBV infection rather than the sex appears to have a more important role in the rapid clearance of HBsAg.
Hepatocellular carcinoma in Karachi
Authors: QURESHI H. , ZUBERI S. J. , JAFAREY N. A. , ZAIDI S. H. M.
Published: March 2008

The present study defines the clinical presentation and examines possible aetiological factors in the occurrence of hepatocellular carcinoma in Karachi, Pakistan.

Histologically proven cases of hepatocellular carcinoma (n= 366) were seen over 16 years. The maximum frequency occurred in the age range 51–60 years (range: 8–98 years), and the male to female ratio was 2.5:1. The place of birth, place of longest stay and various addictions did not have any association with the occurrence of liver carcinoma. Only three cases had a history of liver cancer in their immediate relatives.

The main presenting features were right hypochondrial mass (85%) and pain (79%). The liver size did not correlate with the duration of illness. α‐Fetoprotein titres were more than 200 ng/mL in 62% of cases. Using a reverse passive haemagglutination assay method, HBsAg and anti‐HBc positivity were 32% and 60%, respectively. Antigen figures rose to 60% when radio‐immunoassay was used; 41% of cases were anti‐δ positive (EIA). Aflatoxin contamination varied between 10% and 17% in various localities of Karachi, suggesting an association of liver cancer with HBsAg and aflatoxins.

Histopathologically 73% were trabecular, and 2.5% were mixed hepatocholangiocarcinomas. Follow‐up was available in 45% of cases. All except two (1.2%) died within 6 months.
Radio‐immunoassay for formyl methionyl leucyl phenylalanine. I. Development and application to assessment of chemotactic peptide production by enteric bacteria
Authors: HOBSON C. H. , ROBERTS E. C. , BROOM M. F. , MELLOR D. M. , SHERRIFF R. M. , CHADWICK V. S.
Published: March 2008

Bacterial chemotactic peptides are low molecular weight peptides which stimulate a wide range of neutrophil functions following binding to specific leucocyte receptors. Formyl methionyl leucyl phenylalanine (FMLP) is the major chemotactic peptide in Escherichia coli culture supematants. This paper reports the development and validation of a radio‐immunoassay (RIA) for FMLP and its application to the analysis of formyl peptide production by enteric bacteria in vitro.

The assay was moderately sensitive (10 nmol/L FMLP) and highly specific showing cross reactivity with F‐met‐leu‐tyr, F‐nle‐leu‐phe and F‐met‐met‐met sequences (ID50= 200, 100 and 250 nmol/L, respectively) but no significant cross reactivity with non‐formylated or other formylated di‐ and tri‐peptides (ID50= 105 nmol/L).

Culture supernatants from five species of enteric bacteria were filtered, concentrated and fractionated by reverse phase high performance liquid chromatography before RIA. All five organisms produced immunoreactive F‐met peptides. A major peak of immunoreactivity co‐chromatographing with authentic FMLP was found in all supernatants, but additional peaks representing more hydrophobic peptides were found in Streptococcus faecalis and Bacteroides fragilis cultures. In E. coli culture supernatants, concentration of immunoreactive FMLP increased in a linear fashion during 3 h of log phase growth reaching 31.2 nmol/L (s.e.m. = 10) with final bacterial concentrations of 3 ± 0.73 times 108/mL (n= 6).

These findings extend earlier work showing production of bioactive formyl oligopeptides by different species of enteric bacteria and suggest that a RIA for FMLP will be a useful tool for investigating the production and metabolic fate of such peptides in man.
Radio‐immunoassay for formyl methionyl leucyl phenylalanine. II. Demonstration of an enterohepatic circulation of immunoreactive bacterial chemotactic peptides in man
Authors: ROBERTS E. C. , HOBSON C. H. , ANDERSON R. P. , CHADWICK V. S.
Published: March 2008

Bacterial chemotactic peptides (F‐met‐oligopeptides) are secreted by several species of commensal enteric bacteria and can be assayed by bioassay techniques in human colonic luminal fluid. We have previously demonstrated intestinal absorption and enterohepatic circulation of radiolabelled F‐met peptides introduced into rat colon, and an eightfold increase in absorption and biliary excretion in rats with experimental colitis. This paper describes the application of a radio‐immunoassay to measurements of formyl oligopeptides in human faecal dialysates, colonic and systemic venous blood and bile. All samples were fractionated by reverse‐phase high performance liquid chromatography (HPLC) prior to assay.

Immunoreactivity was found in faecal dialysates (5–700 nmol/L F‐met‐leu‐phe equivalents) and bile samples (3–150 nmol/L) from normal subjects. After HPLC fractionation, up to five distinct peaks of immunoreactivity were identified. One of these co‐chromatographed with authentic F‐met‐leu‐phe; the others probably represented either closely related peptides or peptides of different chain lengths originating from the same F‐met‐leu‐phe precursor protein. Colonic venous blood from two patients with ulcerative colitis contained immunoreactive peptide (10–30 nmol/L) and substantial immunoreactivity was found in ileostomy fluid and bile from two patients with primary sclerosing cholangitis. These results suggest the presence of an enterohepatic circulation of bacterial F‐met oligopeptides in man and provide a basis for studies of the role of such pro‐inflammatory peptides in patients with inflammatory bowel disease and associated hepatobiliary disorders.
Regurgitation of bile acids in rat liver under bile drainage: quantitative analysis by taurine or ursodeoxycholate loading test
Authors: NAKASHIMA TOSHIAKI , NAKAGAWA YOSHIHIRO , SANO ATSUSHI , SAKAMOTO YOSHIKUNI , SHIMA TOSHIHIDE , NAKAJIMA TOSHIKAZU , SETO YOSHIFUMI , OKUNO TADAO , KASHIMA KEI
Published: March 2008

Abstract In rats with an interrupted enterohepatic circulation of bile acids, levels of serum taurine‐conjugated bile acids were increased significantly 3 h after intravenous administration of taurine. Similarly, serum taurine‐ or glycine‐conjugated ursodeoxycholic acid (UDCA) was increased significantly 2 h after UDCA administration. These findings suggested that the administered taurine or UDCA was taken up into hepatocytes and utilized to form conjugated bile acids, which were thereafter regurgitated into the systemic circulation from the liver. The proportion of regurgitated taurine‐conjugated bile acids relative to total serum bile acids measured by taurine loading (30%) almost coincided with that of regurgitated taurine‐ or glycine‐conjugated UDCA relative to total serum bile acids measured by UDCA loading (31.6%). Thus, the present study showed conclusively that at least 30% of serum bile acids are derived from newly conjugated bile acids that are regurgitated from the liver in rats with bile fistula.
Trimethadione tolerance test for the quantitative assessment of liver function in rats
Authors: ISHIKAWA A. , FUKAO K. , TANAKA E. , TSUJI K. , OSADA A. , YAMAMOTO Y. , KIYOSAWA T. , IWASAKI Y.
Published: March 2008

The quantitative estimation of the hepatic functional volume in rats was attempted using the serum dimethadione (DMO)/trimethadione (TMO) ratio in a single blood sampling after oral administration of TMO, which we call the TMO tolerance test, in order to develop a means of pre‐operatively assessing hepatic resectability.

Serum DMO/TMO ratios correlated well with the total amount of the hepatic microsomal TMO‐N‐demethylase activity (enzyme activity) and with the remnant liver weight after 37% and 68% partial hepatectomy. These ratios increased after partial hepatectomy in parallel with the changes in the enzyme activity and the remnant liver weight. The results suggest that the quantitative functional changes of the remnant liver after hepatectomy in both CCl4‐treated and untreated rats can be estimated pre‐operatively by the TMO tolerance test.
Choice of treatments for small hepatocellular carcinoma: Hepatectomy, embolization or ethanol injection
Authors: YAMASAKI SUSUMU , HASEGAWA HIROSHI , MAKUUCHI MASATOSHI , TAKAYAMA TADATOSHI , KOSUGE TOMOO , SHIMADA KAZUAKI
Published: March 2008

The results of hepatectomy, percutaneous ethanol injection therapy and transcatheter arterial embolization for small hepatocellular carcinoma (HCC) of 3 cm or less in diameter from the published literature were compared with the authors’ experiences with surgical treatment. The survival rates for those treated by hepatectomy and ethanol injection were almost the same, being more than 90% at 1 year and 70% at 3 years. The overall results achieved by embolization were inferior to those achieved by the other two therapeutic modalities, although the 1 year survival rate was not worse. The cancer‐free survival rates after hepatectomy and ethanol injection were also similar. Most of the patients with small HCC had associated liver cirrhosis or chronic active hepatitis, but the degree of liver dysfunction and the level of hepatic reserve varied. Anatomically, the number, size, and location of the cancer also varies. Choice of treatment for small HCC should be made based upon the degree of liver function and the anatomic status of the cancer. For example, a patient with multiple (more than four) cancer nodules is a good candidate for embolization. Ethanol injection is indicated for a small HCC, deeply seated in a severely diseased liver. Hepatectomy is the first choice for a small HCC situated near the surface of a liver with relatively good liver function.
Helicobacter pylori infection in children
Authors: HARDIKAR W. , DAVIDSON P. M. , CAMERON D. J. S. , GILBERT G. L. , CAMPBELL P. E. , SMITH A. L.
Published: March 2008

Helicobacter pylori was sought prospectively by culture of antral biopsy, histology and scrology (IgG and IgA) in 440 consecutive endoscopies on children to determine the prevalence, clinical presentation and histological features of H. pylori infection in our population. Twenty‐eight patients had H. pylori (8% overall). The mean age of infected patients was significantly higher than that of non‐infected patients (P < 0.0001). No patient under 5 years of age had H. pylori isolated. Overall, there was no significant difference in clinical presentation between those with and those without H. pylori infection, but 23% of patients between 5 and 26 years of age who presented with abdominal pain as the indication for their endoscopy had H. pylori isolated. Macroscopic changes ranged from no abnormality to frank ulceration, but the typical antral mamilliform changes were 100% predictive of infection. Fifty‐eight per cent of patients with duodenal ulcers, but only 17% with gastric ulcers had H. pylori infection.

Histological gastritis was present in 144 patients (including all H. pylori positive patients). None of the patients with another definable cause for gastritis had H. pylori isolated. In conclusion, H. pylori is an important cause of primary gastritis in our population, occurring in children over 5 years of age. Culture of an antral biopsy should be performed in children over this age undergoing endoscopy for the investigation of abdominal pain and, more particularly, in those with peptic ulceration.
Intestinal lymphokine‐activated killer cells in inflammatory bowel disease
Authors: HOGAN P. G. , GIBSON P. R. , HAPEL A. J. , DOE W. F.
Published: March 2008

The role of non‐specific cytotoxicity in the pathogenesis of inflammatory bowel disease (IBD) was investigated by assaying the natural killer (NK) and lymphokine‐activated killer (LAK) cell activity of lamina propria mononuclear cells (LPMC) from 22 specimens of intestinal mucosa affected by IBD. Only minimal levels of NK activity were detected against K562 cells, as well as colon carcinoma cells, adenoma cells and fibroblasts freshly isolated from the intestinal mucosa. Culture of LPMC from IBD in the presence of interleukin‐2 (IL‐2) generated LAK cells that mediated high levels of activity against K562 cells and against neoplastic epithelial cells and fibroblasts derived from the intestinal mucosa. A group of 20 histologically normal specimens of intestinal mucosa showed similar levels of LAK activity against the K562 and intestinal cell targets. The minimal mucosal NK activity in IBD suggests that the cytotoxic properties of NK cells are not important in the pathogenesis of IBD. The presence of LAK precursor cells in the inflamed mucosa of IBD and their ability to lyse biologically relevant targets in vitro suggests that LAK cells have the potential to contribute to intestinal mucosal injury in IBD.
A randomized controlled study of low‐dose and high‐dose terlipressin in the control of acute oesophageal variceal haemorrhage
Authors: CHANG TING‐TSUNG , LEE FA‐YAUH , TSAI YANG‐TE , LAI KWOK‐HUNG , CHAO YEE , HSIA HSIAO‐CHUNG , LIN HAN‐CHIEH , WANG SUN‐SANG , LEE SHOU‐DONG , LO KWANG‐JUEI
Published: March 2008

A randomized controlled trial was designed to investigate whether a high dose of terlipressin could control acute variceal haemorrhage more effectively than a low dose of terlipressin. Forty cirrhotic patients with bleeding oesophageal varices were included, with low‐dose terlipressin in 21 patients and high‐dose terlipressin in 19 patients. The two groups of patients were similarly matched for all parameters on admission. High‐dose terlipressin (84%) seemed to be more effective in the initial control of bleeding than low‐dose terlipressin (67%); however this difference was not significant. Complete control of bleeding during 24 h of drug infusion was achieved in 53% of patients receiving high‐dose terlipressin and in 48% of those treated with low‐dose terlipressin (P > 0.05). There were no major complications in either group. Mortality in relation to variceal bleeding and transfusion requirements were similar in the two groups. This study shows that high dose terlipressin is not superior to low dose terlipressin in acute variceal bleeding.
Hepatocyte growth factor: Molecular structure and implications for a central role in liver regeneration
Authors: MATSUMOTO KUNIO , NAKAMURA TOSHIKAZU
Published: March 2008

Hepatocyte growth factor (HGF) is a most potent factor for mature parenchymal hepatocytes in primary culture and may act as a trigger for liver regeneration. We purified HGF from rat platelets to homogeneity and cloned both human and rat HGF cDNA. HGF is a heterodimer molecule composed of the 69 kDa α‐subunit and the 34 kDa β‐subunit. HGF has no amino acid sequence homology with other known peptide growth factors and possesses the highest potential among known growth factors to stimulate proliferation of hepatocytes in primary culture. HGF is derived from a single chain precursor of 728 amino acid residues and the precursor is proteolytically processed to form a two‐chain mature HGF. The α‐subunit of HGF contains 4 kringle structures and HGF has a homology (38%) with plasmin. Biologically active recombinant human HGF could be expressed from COS‐1 cells and CHO cells transfected with cloned cDNA. HGF activity and the HGF mRNA level are markedly increased in the liver following insult such as hepatitis, by the administration of hepatotoxins, ischaemia, physical damage and partial hepatectomy. Moreover, HGF mRNA is induced in the lung and kidney, in the presence of liver injury. In situ hybridization revealed that HGF‐producing cells in liver are non‐parenchymal liver cells, presumably Kupffer and sinusoidal endothelial cells. Therefore, HGF from neighbouring cells (Kupffer and sinsuoidal endothelial cells) and distal organs (lung and kidney) may function as a trigger for liver regeneration by both a paracrine mechanism and an endocrine mechanism. HGF has mitogenic activity for renal tubular epithelial cells, epidermal melanocytes and keratinocytes as well as mature hepatocytes, and has the potential to promote cell migration for some epithelial cells, including normal human keratinocytes. Since cell growth and cell motility are relevant to tissue repair and embryogenesis, HGF may well have important roles in tissue repair and embryogenesis as well as in liver regeneration.
Cholestatic jaundice associated with Captopril therapy
Authors: CRANTOCK LUKE , PRENTICE ROGER , POWELL LAWRIE
Published: March 2008

Captopril has attained widespread use as an effective agent in the treatment of heart failure and hypertension. Dermatological, renal and haematological toxicity associated with its use has been widely described and is usually well recognized. There have been comparatively few reports implicating it as causing hepatic drug reactions. Most descriptions have emphasized strongly cholestatic features, although a mixed hepatocellular cholestatic picture and predominant hepatocellular reactions have been reported. Between November 1972 and June 1990 only five cases of possible Captopril‐associated hepatic dysfunction were reported to the Australian Adverse Drug Reaction Advisory Committee. Cases reported suggest equal sex distribution, latent period to development of abnormality between 1 week and 20 months, with slow resolution of jaundice and biochemical abnormality from 1 week to 6 months after withdrawal of the drug. One case of hepatic coma and death with massive acute hepatic necrosis on biopsy has been reported. Not uncommonly the accompanying systemic features suggest a syndrome of drug hypersensitivity.

We report a case of Captopril‐induced cholestatic jaundice in which the abnormality occurred 2 weeks after commencement of the drug and resolved slowly upon discontinuation. The case illustrates two important points: first, the importance of taking a full history, obtaining detailed information about previous drug administration in patients admitted with jaundice; and second, in the case of Captopril‐induced liver disease, the jaundice may persist for many weeks after drug withdrawal.
Transplantation in primary biliary cirrhosis
Authors: SALLIE RICHARD , O'GRADY JOHN , WILLIAMS ROGER
Published: March 2008

Improved immunosuppressive regimens, better postoperative intensive care and judicious patient selection have all resulted in increased patient survival following orthotopic liver transplantation (OLT), which has become the preferred option for most patients with end‐stage primary biliary cirrhosis (PBC). As with most other clinical series, PBC is now the most common indication for OLT in the King's College hospital and Cambridge programmes. To date (30 July 1990), 129 patients with PBC have been transplanted, with overall actual 1 and 5 year survival rates of 65 and 63% respectively. When patients transplanted since 1985 are considered, both the 1 and 2 year survival rates are 78%. Immediate operative morality was 4.5%, generally due to uncontrollable bleeding, while further mortality within 30 days of operation—mainly consequent upon infection and multi‐organ failure—has fallen from 40% prior to 1985 to 9% since 1988. Thirteen per cent of patients have been retransplanted for vanishing bile duct syndrome, manifest in this series invariably within the first 6 months following OLT. Although rehabilitation in this series was excellent, a significant percentage of cases have continuing problems with metabolic bone disease, hypertension and renal impairment, mainly due to cyclosporin toxicity.
Protection by gabexate mesilate (FOY) of the exocrine pancreas in rats with acute pancreatitis induced by a supramaximal dose of caerulein
Authors: HIRANO TETSUYA , MANABE TADAO , TOBE TAKAYOSHI
Published: March 2008

Earlier studies have reported that interstitial oedematous pancreatitis characterized by hyperamylasaemia can be seen during the early stage of stimulation of supramaximal dose of caerulein. The present study investigated the changes in both cellular and lysosomal fragility and the protective effects of a synthetic protease inhibitor gabexate mesilate (FOY) on this non‐invasive model of experimental pancreatitis. The infusion of FOY (50 mg/kg/h) prevented the caerulein‐induced increase in serum amylase and pancreatic oedema formation and reduced the elevated amylase content significantly. The administration of FOY with caerulein also reduced the increased lactic dehydrogenase (LDH) discharge significantly and inhibited the cathepsin B leakage from lysosomes in an in vitro incubation system. These results indicate that FOY plays its protective role at the subcellular level—that is, in lysosomes by inhibiting some proteases such as phospholipase A2. The importance of esterases in the pathogenesis of acute pancreatitis is demonstrated. This type of esterase inhibitor may be valuable clinically in the treatment of acute pancreatitis and these results also suggest the role of lysosomal fragility in the pathogenesis of progression of acute pancreatitis.
Dual colour fluorescein analysis of peripheral blood T cells in auto‐immune chronic active hepatitis
Authors: KATOH TATSUKO , YAMAUCHI KATSUMI , HAYASHI NAOAKI , OBATA HIROSHI
Published: March 2008

Both CD4 and CD8 T cells are subdivided into two phenotypically distinct sublineages via another two T cell markers, Leu‐8 and CD11b antigens. The proportions of these four T cell subsets, CD4+ Leu8+, CD4+ Leu‐8, CD8+ 11b+ and CD8+ 11b‐, were studied in patients with auto‐immune chronic active hepatitis (CAH) and compared with disease controls (hepatitis B surface antigen positive chronic active hepatitis) and healthy controls.

We found that the proportion of CD4+ Leu8+ cells was significantly reduced compared with controls (P < 0.01), whereas those of the other cells were almost identical in all 3 groups. The absolute number of these CD4+ Leu8+ cells was also lower than that of controls (P < 0.01).

Thus, the present study suggests that a reduced number of CD4+ Leu8+ cells is associated with the aberrant immune response in auto‐immune CAH.
Amino acid residues of core region of hepatitis B virus. Asymptomatic carriers versus patients with liver disease
Authors: EHATA TOSHIKI , OMATA MASAO , YOKOSUKA OSAMU , HOSODA KAZUHIKO , OHTO MASAO
Published: March 2008

Recent molecular biological studies have shown that mutations of hepatitis B virus (HBV) genes may have an important role in the pathogenesis of HBV‐induced liver diseases. It has been suggested that the core antigen of HBV could be an immunologic target of cytotoxic T lymphocytes. In this study, nucleotide sequences encoding 183 amino acid residues of the core region of HBV were analysed in 4 asymptomatic healthy carriers and in 5 patients with chronic liver disease, in whom serum aminotransferase levels were fluctuating. A cluster of amino acid substitutions were found from codon 87 to 97 of the core region of HBV in all 5 patients with liver diseases. Such changes were not found in any of the asymptomatic carriers. These data suggest that the peptide sequence spanning 11 amino acid residues in this particular region may play an important role in the pathogenesis of B‐viral liver disease, and could be an immunologic target of cytotoxic T lymphocytes.
Plasma abnormal prothrombin (PIVKA‐π): A new and reliable marker for the detection of hepatocellular carcinoma
Authors: TAKIKAWA YASUHIRO , SUZUKI KAZUYUKI , YAMAZAKI KIYOSHI , GOTO TOSHINORI , MADARAME TAKEO , MIURA YOSHIAKI , YOSHIDA TOSHIMI , KASHIWABARA TOSHIFUMI , SATO SHUNICHI
Published: March 2008

We evaluated the clinical usefulness of a protein induced by vitamin K absence, antagonist‐prothrombin (PIVKA‐π), in detecting hepatocellular carcinoma (HCC) specifically in patients with liver cirrhosis, and the possible correlation between levels of PIVKA‐π and pathological features of HCC. Plasma levels of PIVKA‐π and α‐fetoprotein (AFP) were measured in 628 patients with various diseases, including 253 with liver cirrhosis and 116 with HCC. PIVKA‐π was detected (≥ 0.1 arbitrary unit/mL) in 54.3% of HCC and the concentration showed a positive correlation with the tumour size. As a screening test for the detection of HCC, PIVKA‐π produced values comparable with those of AFP with a sensitivity, specificity and validity of 52.8, 98.8 and 51.6% respectively. Sixteen of 45 patients (37%) with HCC who had low AFP (< 100 ng/mL) levels were positive for PIVKA‐π. No apparent relationship, however, could be found between the levels of PIVKA‐π and the aetiology or pathological findings of HCC. These results suggest that PIVKA‐π can be a reliable marker for detecting HCC in patients with liver cirrhosis.
Effect of glycyrrhizin on lysis of hepatocyte membranes induced by anti‐liver cell membrane antibody
Authors: SHIKI YASUKO , SHIRAI KOHJI , SAITO YASUSHI , YOSHIDA SHO , MORI YOSHIO , WAKASHIN MASAFUMI
Published: March 2008

Studies were made on why glycyrrhizin injection decreases the plasma aspartate aminotransferase (AST) and alanine aminotransferase activities in patients with chronic hepatitis.1 For this, rat hepatocytes were isolated, and incubated with antibody raised against rat liver cell membranes, and the effect of glycyrrhizin on their release of transaminase was investigated. Isolated rat hepatocytes released AST on incubation with anti‐liver cell antibody in the presence of complement. At this time, their endogenous phospholipase A2 activity was increased. Cultured hepatocytes also released the transaminase in the presence of venom phospholipase A2. Glycyrrhizin suppressed the release of transaminase in the presence of either anti‐liver cell membrane antibody or phospholipase A2. These results suggest that antibody treatment raised the phospholipase A2 activity in liver cell membranes, resulting in release of transaminases, and that glycyrrhizin suppressed this increase in phospholipase A2 activity and so inhibited the release of transaminase.
Relationship between intensity of Opisthorchis viverrini infection and hepatobiliary disease detected by ultrasonography
Authors: MAIRIANG EIMORN , ELKINS DAVID B. , MAIRIANG PISALN , CHAIYAKUM JITJAROEN , CHAMADOL NITTAYA , LOAPAIBOON VALLOP , POSRI SUMAREE , SITHITHAWORN PAIBOON , HASWELL‐ELKINS MELISSA
Published: March 2008

Twenty‐four locality‐, age‐ and sex‐matched groups of village residents with no light, moderate and heavy Opisthorchis viverrini infection were examined by ultransonography. Highly significant differences were observed between the groups in the relative size of the left lobe of the liver and the fasting and post‐meal size of the gall‐bladder. In addition, indistinct gall‐bladder wall, the presence of gall‐bladder sludge and strongly enhanced portal vein radicle echoes were most frequently observed in the heavily infected group. Two suspected cases of cholangiocarcinoma were identified from the heavy group. The results highlight the importance of intensity of infection on the frequency and severity of fluke‐associated hepatobiliary disease.
The effect of chilli on gastrointestinal transit
Authors: HOROWITZ MICHAEL , WISHART JUDITH , MADDOX ANNE , RUSSO ANTONIETTA
Published: March 2008

The effects of chilli on gastrointestinal transit (gastric emptying, orocaecal transit, whole gut transit) were evaluated in eight healthy volunteers. In each subject, gastrointestinal transit of a standard test meal was measured on two separate days. On one of these occasions, 20 g of chilli powder was added to the meal. Gastric emptying was quantified with a radioisotopic technique, orocaecal transit by measurement of breath hydrogen concentrations and whole gut transit by counting the number of radio‐opaque markers in the stool. The rate of gastric emptying was slower (P < 0.05) and whole gut transit was faster (P < 0.02) after the meal containing chilli, compared with the other meal. There was no significant difference in orocaecal transit. These results show that ingestion of chilli is associated with significant effects on gastric emptying and intestinal transit.
Is the patient with an arthritic neck at risk during endoscopy?
Authors: BARNSLEY LESLIE , DENHAM JUDITH M. , DUGGAN JOHN M.
Published: March 2008

To determine whether upper gastrointestinal endoscopy poses a risk to patients with arthritis of the neck, 486 members of the Gastroenterology Society of Australia were surveyed by postal questionnaire. Replies were obtained from 323 members. More than 1.5 million endoscopies were covered and 11 respondents had experienced major complications related to neck arthritis. With one exception these were perforations of the upper gastrointestinal tract. There were no reports of serious neurological sequelae. Deaths resulted in two cases. We conclude that neck arthritis rarely causes complications from endoscopy.
Alteration of bile acid metabolism in two‐thirds hepatectomized rat
Authors: NAKAMURA KAZUHIKO , ICHIMIYA HITOSHI , NAKAYAMA FUMIO
Published: March 2008

Bile acid metabolism after two‐thirds partial hepatectomy (PH) in rat was studied. Bile acid kinetics (i.e. synthesis rate and pool size) were determined by wash out method combined with gas liquid chromatography, and serum bile acids by gas liquid chromatography‐mass spectrometry. Serum bile acid concentration was highest on the third day after PH, as the liver regeneration progressed but it gradually decreased with increasing cholic acid (CA)/chenodeoxycholic acid (CDCA), reflecting impaired hepatic uptake of bile acids and/or cholestasis during the early post‐hepatectomy period. Predominance of CA in bile acid synthesis, pool, and biliary secretion was also found. On the third day after PH, liver weight recovered to 66% of the control value, but enhancement of bile acid synthesis was not observed. Consequently, pool size remained at 50% of control. On the seventh day, synthesis of bile acid, especially of CA, was enhanced and pool size and liver weight returned to 68 and 72% of the respective control values. Bile acid synthesis was returned to the control value on the fourteenth day with concomitant restoration of liver weight and bile acid pool size. These changes in bile acid kinetics parallel the events during hepatic regeneration after PH.
Cholestatic hepatocellular carcinoma diagnosed by deposits of Lipiodol and treated by combination of endoscopic retrograde biliary drainage and transcatheter arterial embolization
Authors: SHIINA SHUICHIRO , KOMATSU YUTAKA , KAWABE TAKAO , YOSHIURA KENTA , HAMADA EIJI , HATA YASUO , NIWA YASURO , KAWASE TAKAO , OTA SHINICHI , SHIRATORI YASUSHI , TERANO AKIRA , SUGIMOTO TSUNEAKI
Published: March 2008

Cholestatic hepatocellular carcinoma, which grows into the bile duct and causes obstructive jaundice, is rare and difficult to diagnose. A case is presented in which cholestatic hepatocellular carcinoma was detected by deposit of Lipiodol. This is also the first case that was successfully treated by endoscopic retrograde biliary drainage and transcatheter arterial embolization.
The role of the vagus nerve in the protective action of acid inhibitors on ethanol‐induced gastric mucosal damage in rats
Authors: CHO C. H. , CHEN B. W. , HUI W. M. , LAM S. K. , OGLE C. W.
Published: March 2008

The role of vagus in the actions of different acid inhibitors on ethanol‐induced gastric damage and mucosal blood flow (GMBF) changes was studied in anaesthetized rats, using an ex vivo stomach chamber preparation. Subdiaphragmatic bilateral vagotomy decreased the basal gastric acid secretion and GMBF; it also intensified ethanol‐evoked lesions in the glandular mucosa. Misoprostol, omeprazole and cimetidine produced a similar degree of reduction in acid output. Misoprostol given subcutaneously (s.c.) (50 μg/kg), or added to the incubation solution (12.5 μg) for 15 min, markedly prevented ethanol‐induced lesion formation and reduction in GMBF. The reversing effect of s.c. injection of misoprostol on either lesion formation or on GMBF reduction was attenuated by vagotomy. Omeprazole protected against lesion formation only when present in the incubation solution (12.5 mg) of ex vivo chamber preparations of both vagus‐intact and vagotomized animals, but the effect was significantly less in the latter group. The drug also prevented the depressive action of ethanol in vagus‐intact animals. Cimetidine pretreatment (50 mg s.c. or 12.5 mg in incubation solution), however, did not modify the effects of ethanol on lesion formation and the GMBF. The findings indicate that the three different types of acid inhibitors exert different actions on ethanol‐induced gastric mucosal damage, although they produced similar inhibition of acid output. Vagotomy lowers the GMBF and attenuates the antiulcer action of misoprostol and omeprazole, especially when the drugs are given by the parenteral route.
Liver, lipoproteins and disease: II. Clinical relevance of disordered cholesterol metabolism in liver disease
Authors: POWELL ELIZABETH E. , KROON PAULUS A.
Published: March 2008

The alterations in the concentration and composition of lipoproteins that occur in liver disease indicate the central role of the liver in lipoprotein metabolism. A number of studies have characterized plasma lipoproteins in patients with liver disease, although in most cases the underlying molecular defects responsible for the changes are still undetermined.
Differential lectin reactivities of α‐fetoprotein in hepatocellular carcinoma: Diagnostic value when serum α‐fetoprotein levels are slightly raised
Authors: STADEN LOUISE VAN , BUKOFZER STANLEY , KEW MICHAEL C. , SAVAGE NERINA
Published: March 2008

The specificity and sensitivity of α‐fetoprotein (AFP) binding to Concanavalin‐A (Con‐A) and Lens culinaris agglutinin (LCA) in 26 South African blacks with advanced symptomatic hepatocellular carcinoma (HCC) but only slightly raised serum AFP concentrations (20–500 ng/mL) was compared with that in patients with similar serum AFP levels from diseases that might be mistaken clinically for HCC (seven ‘benign’ liver disease [BLD] patients and six with metastatic liver disease [MLD] from gastrointestinal tumours). Con‐A–Sepharose‐4B affinity chromatography did not differentiate between the different groups: fucosylation rations for the HCC patients were 0.81 ± 0.60, compared with 0.63 ± 0.27 and 0.54 ± 0.32 in patients with BLD and MLD, respectively. Electrophoresis of AFP serum and fractions in the presence or absence of Con‐A and LCA showed an increase in the AFP C2 band. Rank correlation analysis of the AFP L2 and L3 bands combined could distinguish between patients with HCC and other hepatic diseases (P < 0.05).
Combination therapy with ursodeoxycholic acid and colchicine for primary biliary cirrhosis
Authors: SHIBATA JUNJI , FUJIYAMA SHIGETOSHI , HONDA YOSHIKAZU , SATO TATSUO
Published: March 2008

Twelve patients with primary biliary cirrhosis (PBC), stages I to III, received long‐term therapy with a combination of 600 mg ursodeoxycholic acid (UDCA) and 1 mg colchicine given daily for more than 2 years. Drug toxicity was mild; one patient experienced diarrhoea that was probably due to colchicine. Serum levels of bilirubin, alkaline phosphatase (ALPase), γ‐glutamyl transpeptidase and alanine aminotransferase decreased by more than 50% of the initial values. Serum albumin and cholesterol levels also improved, but immunoglobulins and anti‐mitochondrial antibody titre did not change. Histologic features in the eight patients who received serial liver biopsies before and 2 years after the beginning of treatment were evaluated. Piecemeal necrosis and portal inflammation were improved, but there was no change in portal fibrosis. Patients were divided into two groups; the first received both drugs from the outset, and the second group were started on UDCA for 3 months followed by the addition of colchicine. After 3 months, the improvement in serum bilirubin and ALPase in the first group was greater than in the second. However, in the second group, the ALPase levels had decreased significantly when measured at 6 and 9 months after the treatment compared with the levels at 3 months. These findings suggest that UDCA and colchicine may have a synergistic effect. This combination therapy appears to be safe and effective, both clinically and histologically, for treating PBC.
Enhanced vasoconstrictor response of the isolated perfused cirrhotic rat liver to humoral vasoconstrictor substances found in portal venous blood
Authors: GROSSMAN H. J. , GROSSMAN V. L. , BHATHAL P. S.
Published: March 2008

Humoral vasoconstrictor factors in portal venous blood have an important influence on hepatic vascular tone. The aim of this study was to determine whether there is altered reactivity of the intrahepatic portal vascular bed of cirrhotic livers to such factors. Isolated perfused rat liver preparations (IPRLP) obtained from rats with carbon tetrachloride‐induced cirrhosis and from normal controls were treated with small aliquots of fresh, heparinized venous blood (4% vol/vol) added to a synthetic perfusate composed of 2.5% bovine serum albumin in Krebs‐Henseleit buffer. Compared with blood from the inferior vena cava, portal venous blood produced a greater increase in perfusion resistance of normal IPRLP (2.8 ± 0.7 vs 15 ± 3%, P 0.05). There was no significant difference in the response of normal IPRLP to portal venous blood obtained from cirrhotic animals compared with portal blood from normal controls (10 ± 4 vs 15 ± 3%). However, cirrhotic IPRLP were significantly (P < 0.05) more responsive to portal venous blood than were control livers, regardless of whether the blood was obtained from control (28 ± 6%) or cirrhotic (24 ± 6%) rats. The response of both control and cirrhotic IPRLP to portal blood could be partially inhibited by the α‐adrenoceptor antagonist phentolamine (5 × 10−6mol/L) and cirrhotic IPRLP were more responsive than controls to exogenous noradrenaline (518 ± 27 vs 363 ± 21%, P < 0.01). It is concluded that there is no significant difference in the intrahepatic vasoconstrictor activity of portal venous blood from normal or cirrhotic rats, and that the portal vascular bed of the cirrhotic rat liver shows enhanced vasoconstrictor responses not only to portal venous blood, obtained both from normal and cirrhotic rats, but also to exogenous noradrenaline.
Gastric mucosal barrier: Intergranular matrix of gastric surfactant in the mucous lining
Authors: HILLS B. A.
Published: March 2008

Transmission electron microscopy of rat gastric mucosa fixed by a novel procedure designed for barriers to watersoluble solutes has shown that the intergranular matrix material of gastric mucus is oligolamellar surface‐active phospholipid. It is a gastric surfactant similar to that seen on deeper mucus‐free surfaces also exposed to acid.
Diabetes mellitus and operated peptic ulcer disease
Authors: DUGGAN JOHN M. , O'KEEFE ELIZABETH A. , WEAVER AMY L. , ZINSMEISTER ALAN R. , MELTON L. JOSEPH
Published: March 2008

There is some evidence of an antagonism between peptic ulcer and diabetes mellitus. This antagonism is possibly related to anomalous insulin metabolism in duodenal ulcer patients. To evaluate this issue, 471 Rochester, Minnesota residents who had surgery for peptic ulcer were examined and then followed for up to 34 years. Their experience of diabetes mellitus was compared with that of Rochester residents generally, for whom data on diabetes incidence and prevalence were available. At surgery, the prevalence of diabetes was somewhat increased for gastric and slightly diminished for duodenal ulcer patients. Of the 445 patients who were free of diabetes at surgery, 27 developed it. By 20 years, the cumulative incidence of diabetes (9.1%) was less than expected (10.3%), but over the 20 years the difference was not significant for either gastric or duodenal ulcer patients. The risk of diabetes was not influenced by age, gender, or smoking status but analyusis for relative weight at surgery indicated that obese patients had a 2.6‐fold increase in risk of subsequent diabetes, whereas those with < 1.2 relative weight had reduced risk. Relative weight was the only significant predictor of the time to subsequent diabetes in a proportional hazards regression analysis. The proposition of an antagonism between peptic ulcer and diabetes is not supported by the data.
Endoscopic management of bile duct stones
Authors: SAUERBRUCH TILMAN
Published: March 2008

The surgical risk of common duct exploration for the treatment of biliary calculi is considerably higher than that of cholecystectomy. Therefore, introduction of endoscopic sphincterotomy in 1974 was a major advance. It has become the therapy of choice in cholecystectomized patients or in those with an increased operative risk. Endoscopic sphincterotomy has a mortality rate of around 1% and a morbidity rate of 7%. These figures compare favourably with open surgery, especially in old patients. The procedure fails in about 10% of all patients referred for endoscopic removal of their calculi. However, several techniques have been described or are currently under evaluation to overcome these failures: intracorporeal or extracorporeal lithotripsy, long‐term stenting of the bile duct, or direct application of solvents. Long‐term follow‐up studies show that between 2% and 20% of successfully managed patients may develop recurrent stones, mainly caused by bile stasis and infection. Patients with a functioning gall‐bladder and no concomitant gall‐bladder stones probably do not require cholecystectomy after successful endoscopic treatment of their choledochal stones. While endoscopic stone removal has replaced surgery in the elderly frail patients it has no major advantages in the young and fit patients, especially when the gall‐bladder is still in situ.
Chlormezanone‐induced fulminant hepatitis in a pregnant woman: Successful delivery and liver transplantation
Authors: BOURLIERE M. , TREUT Y. P. LE , MANELLI J. C. , BOTTA‐FRIDLUND D. , BERTOLINO J. G. , BOUBLI L. , SANSON D. , POL B. , BRICOT R. , GAUTHIER A. P.
Published: March 2008

The case of a 29 year old woman affected by fulminant hepatitis during the third trimester of pregnancy, after a 3 week administration of chlormezanone is reported. Following induced Caesarean delivery, the patient underwent an orthotopic liver transplantation. The mother and her baby were in good condition 26 months after liver transplantation. In this case, chlormezanone was probably responsible for the fulminant hepatitis.
Persistent ileitis after ileal salvage from a failed Kock pouch
Authors: SILVA H. J. DE , MORTENSEN N. J. McC.
Published: March 2008

A case of persistent ileitis following the refashioning of a Kock ileal pouch into a Brooke ileostomy for severe pouchitis is reported. Preserving the terminal ileum by a salvage procedure may not be a safe alternative to pouch excision with the formation of a new end ileostomy in the surgical management of pouchitis refractory to medical treatment.
Alpha‐fetoprotein expression in hepatocellular carcinoma: A clinical study
Authors: MUGUTI G. , TAIT N. , RICHARDSON A. , LITTLE J. M.
Published: March 2008

α‐Fetoprotein (AFP) levels were studied in 51 consecutive patients with hepatocellular carcinoma that presented to the Surgical Hepatobiliary Unit at Westmead Hospital over 12 years. Twenty‐three were hepatitis surface antigen (HBsAg) positive and 13 of those patients were Asian. Thirteen patients drank more than 60 g of alcohol each day. A significantly raised level of AFP was defined as more than 20 ng/mL, and 31 of the 51 patients had AFP levels exceeding this at some stage during surveillance. Twenty‐five demonstrated levels above 200 ng/mL. Univariate statistical methods suggested that men were more likely to express raised AFP than women, Asians more likely than other races, patients with chronic active hepatitis more likely than those without and those with chronic hepatitis B infection more likely than those who were HBsAg negative. Those who drank more than 60 g alcohol each day were less likely to demonstrate a raised serum AFP than those who drank less. Multivariate logistic regression demonstrated that HBsAg carriage was the only statistically significant independent determinant of a raised AFP. Age 65 years or more was associated with a chance of a raised AFP.
Tattooing and hepatitis B infection
Authors: SEBASTIAN V. J. , RAY S. , BHATTACHARYA S. , MAUNG O. TIN , SAINI H. A. MD , JALANI HJ DAUD
Published: March 2008

To determine the prevalence of HBV carrier status in tattooed persons, 200 healthy, tattooed volunteers and 200 non‐tattooed volunteers to match the first group for age, sex and ethnic group were screened. Prevalence of HBsAg in tattooed and non‐tattooed volunteers was 19.5 and 9% respectively, which was a statistically significant difference (P < 0.01). There was no difference in the prevalence in various age groups, ethnic groups, or sex, between the two groups.