bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastric carcinoma in young Hong Kong Chinese
Authors: CHEUNG A. N. Y. , KHOO U. S. , NG I. O. L.
Published: March 2008

Gastric carcinomas usually occur in older people. Those occurring in the young are uncommon. The pathological and clinical features of gastric carcinomas were reviewed in 42 Chinese patients who were 35 years of age and younger. The data were obtained from the record files of the University Department of Pathology, Queen Mary Hospital for the period 1976–85. The patients comprised 4% of the total cases of gastric carcinomas in that period. These patients (age range: 20–35 years, mean: 30 years) showed a male to female ratio of 1: 2.5 which differs from the usual male preponderance seen in gastric carcinoma. Among the 27 cases with known staging, 22 (81.5%) were stage III or IV. Twenty‐five cases had an ulcerative appearance. All were adenocarcinomas and the majority (83.3%) were poorly differentiated. Associated dysplasia was found in 35 (83.3%) cases, although only 14 of these were in association with poorly differentiated adenocarcinomas. Intestinal metaplasia was found in 13 cases and, when present, involved less than 30% of the mucosa. Only two cases were of type III metaplasia. The findings show that gastric carcinoma in young Chinese tended to occur more frequently in females, presented at late stages, showed poor glandular differentiation, was frequently associated with gastric dysplasia and had minimal association with intestinal metaplasia.
Fluoride as a possible aetiological factor in non‐ulcer dyspepsia
Authors: GUPTA I. P. , DAS T. K. , SUSHEELA A. K. , DASARATHY S. , TANDON R. K.
Published: March 2008

A prospective case controlled study was conducted to evaluate the role of fluoride as a possible aetiological factor for non‐ulcer dyspepsia (NUD). Twenty patients with NUD and 10 age and sex matched healthy controls were subjected to clinical evaluation, upper gastrointestinal endoscopy and biopsies from the gastric antrum and duodenum. The antral and duodenal mucosa was subjected to a rapid urease test for Helicobacter pylori and histological and electron microscopic examinations. Fluoride levels in the drinking water, serum and urine were estimated using a ION 85 ionanalyser. These levels were significantly higher in patients with NUD than in controls (P < 0.05). Histological abnormalities in the antral and duodenal mucosa were seen in 14 patients (70%) with NUD and 1 control subject (10%) (P < 0.05). Electron microscopic abnormalities in the mucosal cells were seen in all patients with NUD but in none of the controls (P < 0.01). The fluoride levels in serum and urine correlated with the symptoms, histological and electron microscopic abnormalities (P < 0.05). It was concluded that chronic exposure to fluoride may result in NUD and should be considered in patients where other known causes of dyspepsia have been excluded.
Striking variability of hepatic copper levels in fulminant hepatic failure
Authors: MCDONALD J. A. , SNITCH P. , PAINTER D. , HENSLEY W. , GALLAGHER N. D. , MCCAUGHAN G. W.
Published: March 2008

Two cases of acute hepatic failure are reported in which the diagnosis of Wilson's disease was considered because of low serum ceruloplasmin, low serum copper levels and high 24 h urinary copper. Case 1 had Kayser‐Fleischer rings, haemolysis and a high 24 h urinary copper, and so Wilson's disease was confidently diagnosed. Case 2 had high urinary copper excretion, but [64Cu] study indicated a 24: 2 h ratio of 0.7 and made the diagnosis of Wilson's disease uncertain. Both patients underwent orthotopic hepatic transplantation, and multiple biopsies were taken from the resected specimen in order to estimate hepatic copper levels. In both cases, hepatic copper levels revealed considerable variation: 0.8–5.2 μmol/g dry wt (case 1) vs 0.02–12.65 μmol/g dry wt (case 2). In case 1, only two of 14 levels were within the diagnostic range for Wilson's disease (> 4 μmol/g dry wt), whereas hepatic copper levels in case 2 were in the Wilsonian disease range in three of 16 specimens. These results were in contrast to uniformly high hepatic copper levels in one patient with established cirrhosis secondary to Wilson's disease and two cases of primary biliary cirrhosis. This report indicates that hepatic copper levels vary greatly in acute liver failure, and that estimates from a single biopsy specimen may be misleading as to the cause of the underlying liver disease.
Field evaluation of a rapid, simple and inexpensive urease test for the detection of Helicobacter pylori
Authors: KATELARIS P. H. , LOWE D. G. , NORBU P. , FARTHING M. J. G.
Published: March 2008

A modified rapid urease test (MRU test) for the detection of Helicobacter pylori was evaluated under field conditions during an endoscopic survey in rural India and compared with a commercially available urease test (CLO test) and with histology. Of 195 consecutive subjects who underwent upper gastrointestinal endoscopy, 153 (78.5%) were positive for Helicobacter pylori when tested by the CLO test and/or histology. The sensitivity and specificity of the MRU test relative to this was 97.4 and 95.2%, respectively when the test was read over a 3 h period. The MRU test was positive in 77.4, 89.0, 93.8 and 96.6% of cases at 1, 5, 20 and 60 min, respectively, compared with 2.7, 14.4, 48.6 and 71.2% of cases for the CLO test at the same time.

The accuracy of the MRU test was thus similar to that of other methods for the detection of Helicobacter pylori. Furthermore, it gave a positive diagnosis more rapidly than other tests, in most cases before the subject had left the endoscopy suite. The MRU test is extremely simple to prepare and read and costs less than £0.05 per test compared with £2.26 for a CLO test. It is suitable for use in clinical or epidemiological work and especially where cost factors are critical.
Adaptation of rat gastric mucosa to repeated doses of non‐salicylate non‐steroidal anti‐inflammatory drugs
Authors: SKELJO M. V. , GIRAUD A. S. , YEOMANS N. D.
Published: March 2008

To determine whether gastric mucosal adaptation occurs to the damaging effects of repeated non‐steroidal anti‐inflammatory drug (NSAID) administration, we compared the extent of gastric damage in rats after single or repeated doses of four non‐salicylate NSAID. With daily dosing, adaptation occurred only to repeated doses of the short‐acting NSAID ibuprofen and diclofenac but not to indomethacin and naproxen, both of which have considerably longer half‐lives. Adaptation to indomethacin was demonstrable if the dosage interval was lengthened and the drug was given on alternate days rather than daily. Histological examination of the gastric mucosa of diclofenac‐treated rats showed a similar degree of superficial damage in the single and repeatedly dosed groups. However there was a highly significant reduction in the amount of deeper mucosal damage in the repeatedly dosed rats. Our findings show that under certain conditions of dosage, adaptation to non‐salicylate NSAID is demonstrable. The pharmacokinetics of individual NSAID appear to be important in determining whether or not adaptation occurs. Histological examination showed that adaptation to one of the shorter acting NSAID, diclofenac, was characterized by a significant reduction in deeper mucosal damage.
The role of hepatitis B virus in the development of primary hepatocellular carcinoma: Part I
Authors: ROBINSON WILLIAM S.
Published: March 2008

Chronic infections with hepatitis B virus (HBV) of humans and animal hepadnavirus infections in their natural hosts are strongly associated with primary hepatocellular carcinoma (HCC). Although viral integrations are found in cells of many HCC, no general viral‐specific hepatocarcinogenic mechanism for hepadnaviruses has been identified. In approximately one half of HCC in woodchuck hepatitis virus (WHV) infected woodchucks, viral integrations near the c‐myc or N‐myc genes have been reported which result in enhanced expression of the respective gene. Such host gene‐specific insertional mutagenesis has not been found in HCC of other hepadnavirus infected hosts. Thus in humans, ground squirrels and ducks hepadnaviral integrations appear to be at different host chromosomal DNA sites in each HCC and few integrations have been found within or near any cellular gene. Other possible hepadnavirus‐specific carcinogenic mechanisms that are being investigated include transactivation of cellular gene expression by an hepadnavirus gene product (e.g. the X‐gene), and mutation of host genes by unknown hepadnavirus‐specific mechanisms. It should be noted, however, that chronic hepadnavirus infection is associated with chronic necroinflammatory liver disease with hepatocellular necrosis and regeneration (sometimes leading to cirrhosis in humans), a pathological process that is common to numerous other risk factors for HCC. This suggests the possibility that this pathological process is hepatocarcinogenic irrespective of the inciting agent and the role of hepadnavirus infection is no different from that of other risk factors in causing chronic necroinflammatory liver disease.
Colonic malacoplakia: Unusual association with ulcerative colitis
Authors: NG IRENE O. L. , NG MATTHEW
Published: March 2008

Abstract A 44 year old Chinese female with malacoplakia of the colon associated with ulcerative colitis was presented. The patient showed typical histological, electron microscopic and X‐ray micro‐analysis findings of malacoplakia. The malacoplakia gradually disappeared after discontinuation of high‐dose systemic steroid prescribed by private practitioner for the ulcerative colitis. A review of the 26 previously reported cases of malacoplakia of the colon is also included. Coupled with the clinical events of this patient, it appears that malacoplakia is likely to be secondary to immunosuppression, due to drugs, malignant or debilitating diseases.
Significance of sublobular hepatic necrosis in the progression of chronic hepatitis C
Authors: KAJINO K. , HORIIKE N. , TANIMOTO K. , MICHITAKA K. , NONAKA T. , KANDA K. , NAKANISHI K. , DOI K. , MASUMOTO T. , MATSUURA B. , ONJI M. , OHTA Y.
Published: March 2008

Abstract The clinical characteristics of hepatitis C virus associated chronic liver diseases (C‐LD) in 17 patients were compared with hepatitis B virus associated diseases (B‐LD) in 47 patients, by analysing the histological findings of the liver and the change in serum alanine aminotransferase (ALT) level. The persistence of the moderate abnormality in ALT (> 100 IU/L) for longer than 1 year was more frequently seen in the C‐LD group (P < 0.01), although the severe exacerbation of the disease with ALT higher than 500 IU/L was more frequent in the B‐LD group (P < 0.01). The patients with the histological finding of sublobular hepatic necrosis (SN) in the C‐LD group progressed to advanced stages more frequently than those with SN in the B‐LD group (P < 0.05). Furthermore, nine of 10 patients with SN in C‐LD finally progressed to hepatocellular carcinoma (HCC) in 52 ± 23 months, whereas three of 16 with SN in B‐LD developed HCC in 81 ± 34 months. Although the morphological features of SN in C‐LD and B‐LD were almost the same, SN in C‐LD seemed to be a more significant diagnostic condition for the progression to liver cirrhosis or HCC. The patients with SN in the C‐LD group should be closely followed for the early detection of HCC, although further study with a greater number of patients is necessary.
Enhanced production of leukotriene B4 by peripheral blood mononuclear cells in patients with fulminant hepatitis
Authors: ASANO F. , MORIWAKI H. , SHIRATORI Y. , SHIMAZAKI M. , SAKAI T. , KOSHINO Y. , MURAKAMI N. , SUGIHARA J. , OHNISHI H. , SAITO K. , MUTO Y.
Published: March 2008

Abstract The production rate of leukotriene B4 (LTB4) was measured using peripheral blood mononuclear cells (PBMC) in patients with fulminant hepatitis (FH) or other liver diseases. LTB4 in the culture media of PBMC under stimulation with Ca‐ionophore was fractionated by HPLC and measured by radioimmunoassay. The production rate of LTB4 was elevated in 16 of 17 FH patients (3.3 ± 0.2 ng/106 cells for 5 min), while the production was below detectable level in patients with acute or chronic hepatitis and in healthy controls. In FH patients, the highest production rate of LTB4 was observed in the initial period of the disease. Enhanced LTB4 production may indicate the primed state of PBMC — the primed mononuclear cells are regarded as participating in the development of massive liver necrosis and of other organ failures in FH.
Rectal varices in extrahepatic portal hypertension
Authors: PAI C. G. , THOMAS V. , HARIHARAN M. , NAIR K. V.
Published: March 2008

Abstract Rectal varices, as distinct from haemorrhoids, occur due to high pressure in the inferior mesenteric venous system in patients with portal hypertension. The exact prevalence of rectal varices in extrahepatic portal hypertension is unknown. To determine this, 116 patients with extrahepatic portal hypertension were studied for the presence of rectal varices. These lesions were found in 103 (88.8%) patients. Bleeding from rectal varices occurred in 14.6% of patients. Massive bleeding requiring hospitalization and blood transfusion was not encountered. It is concluded that rectal varices are common in extrahepatic portal hypertension. Bleeding from them is uncommon, and often mild and self‐limiting. The available literature is reviewed and the importance of recognizing the condition stressed.
High prevalence of duodenal ulcer in Indochinese immigrants attending an Australian university hospital
Authors: KOLT S. D. , KRONBORG I. J. , YEOMANS N. D.
Published: March 2008

Indochinese migrants to Australia appear to have a high prevalence of duodenal ulcer (DU). To examine this hypothesis a 2 year audit of the prevalence of symptomatic DU among patients attending a general hospital was conducted. The last 6 months of this period included a prospective assessment of ulcer risk factors. In Australian‐born patients DU prevalence was 8.4 per 1000 admissions. By comparison, prevalence in Indochinese was 24.6 per 1000 admissions (P < 0.001) with an age standardized prevalence of 30.3 per 1000 (P <0.001). This represented a relative risk in Indochinese of 2.9 using crude data and 3.6 after age standardization. The increased risk was demonstrated only in males: very few DU were diagnosed in female Indochinese. Ulcer prevalence increased in Indochinese for each age decile between 10 and 80 years, with statistical significance (P < 0.01) reached in the age brackets 0–19, 20–39 and 60–79 years. Ulcer prevalence was also increased in some other ethnic groups. However, when referral bias was taken into account (by calculating the ratio of endoscopies to total admissions for each group), a significant increase in DU prevalence could only be confidently demonstrated in Indochinese. Analysis of risk factors showed that among DU patients, Indochinese were significantly less likely to smoke (P < 0.05) and also had a tendency to ingest less non‐steroidal anti‐inflammatory drugs (NSAID) and to consume less alcohol.
Safety and immunogenicity of hepatitis A vaccine in healthy adult volunteers
Authors: HORNG YOW‐CHERNG , CHANG MEI‐HWEI , LEE CHIN‐YUN , SAFARY A. , ANDRE FRANCIS E. , CHEN DING‐SHINN
Published: March 2008

The immunogenicity and adverse reaction of an inactivated hepatitis A (HA) vaccine were investigated. Sixty healthy adult volunteers who lacked antibody to HA virus (anti‐HAV) received three doses of vaccine containing 720 enzyme‐linked immunosorbent assay (ELISA) units (EL.U) according to a 0, 1 and 6 month schedule. Blood tests for serum liver enzymes and anti‐HAV were performed at screening 7 days prior to, and 1, 6 and 7 months after the first dose. Anti‐HAV was tested by radio immunoassay and ELISA for titre determination. The seroconversion rates measured by ELISA were 98.3% (59/60) at months 1 and 6 and 100% at month 7. Sixty‐one per cent (109/180) of the documented injections were followed by local symptoms, essentially mild soreness at the site of injection; and 22.2% (40/180) by minor general symptoms including malaise, fatigue and lethargy. It is concluded that HA vaccine is highly immunogenic and safe. It may replace immunoglobulin as an effective method of preventing HA virus infection in adults.
Obstructed defecation
Authors: SUN WEI MING
Published: March 2008

Obstructed defecation is one of the causes of chronic constipation. Clinical tests suggest that patients with obstructed defecation have impaired pelvic floor function. Appropriate management relies on proper identification of the underlying pathophysiology.
Nipradilol, a new β‐blocker with vasodilatory properties, in experimental portal hypertension: A comparative haemodynamic study with propranolol
Authors: UM SOONHO , NISHIDA OSAMU , TOKUBAYASHI MASAKI , KIMURA FUMIKO , KITA TORU
Published: March 2008

The haemodynamic effects of nipradilol, a new non‐selective β‐adrenoreceptor blocker with vasodilating actions like nitroglycerin, were examined in rats with portal hypertension due to portal vein stenosis. Portal hypertensive rats were divided into five groups receiving infusion of placebo, 3 mg of propranolol, 300, 600 and 1200 μg of nipradilol. At its highest dose, nipradilol achieved a reduction of 34.4 ± 4.4% in heart rate which was similar to that in the propranolol group (36.5 ± 2.4%). Also for other systemic haemodynamic parameters, the nipradilol 1200 μg group exhibited changes not significantly different from those in the propranolol group; mean arterial pressure (‐ 13 vs ‐ 14%), cardiac index (‐ 37 vs ‐ 31%) and systemic vascular resistance (+ 29 vs+ 32%). In contrast to the similar changes in the systemic circulation, a 1200 μg dose of nipradilol lowered portal pressure significantly more than propranolol (‐ 4.3 ± 0.6 vs ‐ 2.9 ± 0.2 mmHg, P≤ 0.05). Nipradilol then reduced portal blood flow by 22% (P≤ 0.05) without a significant change in portocollateral resistance. On the other hand, propranolol not only caused a reduction in portal blood flow of 30% (P≤ 0.01), but also an increase in portocollateral resistance of 21% (P≤ 0.05). The results suggest that nipradilol may ensure a more effective control of portal hypertension than propranolol, presumably via its venodilatory action on portocollateral vessels.
Local spread of HDV infection transiently occurring in Japan
Authors: IWANAMI EIICHI , YANO MICHITAMI , KOGA MICHIAKI , SHIRAHAMA SATOSHI , TSUDA TOMIYASU
Published: March 2008

Hepatitis B virus (HBV) carriers and patients with acute hepatitis B living in the Kamigoto islands, a part of Japan with a high incidence of HBV carriage, were retrospectively tested for serum anti‐hepatitis D virus (anti‐HDV) and they were compared with the inhabitants of Oita City (an area with an average HBV carriage rate).

The prevalence of anti‐HDV in HBV‐infected individuals was 8.3% (42/507) in Kamigoto and 0% (0/101) in Oita City. With one exception, all of the positive serum samples in Kamigoto were collected before 1986, and the mean age of the positive individuals was significantly younger than that of the negative individuals (P < 0.005). Among the 42 anti‐HDV‐positive patients, nine (21%) had definite liver disease. The route of infection was uncertain in most cases (i.e. sporadic), but two pairs of mothers and children were detected.

Although the prevalence of anti‐HDV positivity in Japan has been reported to be very low (about 1% or less), the present investigation showed that the local spread of HDV infection in Kamigoto occurred on a minor scale up to 1986. The infections presumably resulted from the closed environment and the high incidence of HBV carriage in these islands. Accordingly, there could be a considerable risk of the outbreak of HDV infection in the future under similar conditions, even in countries where the disease has never been detected previously.
A follow up of 53 adult patients alive beyond 2 years following liver transplantation
Authors: McCAUGHAN G. W. , O'BRIEN E. , SHEIL A. G. R.
Published: March 2008

Although hepatic transplantation is now a well‐accepted treatment modality for end‐stage liver diseases there are little detailed data on the clinical profile of patients who survive beyond 1 year following transplantation. The aim of this study was to develop a cross‐sectional profile on 53 adults who have survived beyond 2 years following liver transplantation. These patients have been followed for a mean of 43.5 months (range 24–84) since the time of transplant. Nineteen patients had persisting liver enzyme abnormalities, 11 due to chronic viral hepatitis (seven hepatitis C virus, three hepatitis B virus), four due to biliary disease. Two had post severe rejection, one steatosis secondary to obesity while in one the aetiology was unclear. Nineteen (36%) of patients required anti‐hypertensive medications. The median doses of Prednisone, Cyclosporin and Imuran were 7.5, 300 and 50 mg daily, respectively. The mean serum creatinine was 117 ± 27 μmol/L. However 22 (41%) had an elevated serum creatinine (> 120 μmol/L) but in only seven was the serum creatinine > 150 μmol/L. Fourteen (26%) of patients were obese (body mass index > 30) whilst 46% had a higher than recommended serum cholesterol (mean level 5.6 ± 1.5 μmol/L). There has only been one case of internal malignancy (lymphoma) although 19 patients attend regular dermatological review for skin cancer surveillance. Forty‐eight patients had a Karnofsky Score > 80.

In conclusion, the vast majority of these patients have excellent clinical function but some caution is required with respect to renal function, hypertension, obesity and mild hypercholesterolaemia. Persisting liver abnormalities in 37% of patients highlight the need for continued close monitoring in the long term.
Low prevalences of HBV and HCV infection in patients with primary biliary cirrhosis in Taiwan: A case control study
Authors: CHIEN RONG‐NAN , SHEEN I‐SHAYN , LIAW YUN‐FAN
Published: March 2008

To study the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with primary biliary cirrhosis (PBC) against the background of HBV and HCV infection in the general population, serum specimens from a consecutive series of 27 patients with PBC and 108 age/sex matched ‘healthy subjects’ as control group were submitted to assays for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti‐HBc), antibody to hepatitis B surface antigen (anti‐HBs) and antibodies to hepatitis C virus (anti‐HCV). None of the patients with PBC were HBsAg or anti‐HCV positive while 17 (15.7%) and 6 (5.6%) of ‘healthy’ controls were HBsAg positive and anti‐HCV positive (P= 0.017 and 0.26). Patients with PBC also had a significantly lower prevalence of HBV infection than matched controls (70.4%vs 88.9%, P= 0.022). The results suggest that neither HBV nor HCV plays any significant role in the pathogenesis of PBC, and that PBC would not develop or be masked in patients with HBV or HCV infection.
Neuronal nitric oxide in the gut
Authors: BROOKES SIMON J. H.
Published: March 2008

Motility of the gastrointestinal tract is directly controlled by enteric inhibitory and excitatory motor neurons that innervate the layers of smooth muscle. Inhibitory motor neurons mediate receptive and accommodative relaxations and control the opening of sphincters, thus playing an important role in normal gut motility. Recent studies have demonstrated that nitric oxide (NO) is an important neurotransmitter released by inhibitory motor neurons in animal and human gut. Antagonists of nitric oxide synthase (NOS), the synthetic enzyme for NO, reduce the effectiveness of transmission from inhibitory motor neurons. Exogenous NO mimics inhibitory nerve activation, and a variety of compounds that affect the availability of endogenously produced NO modulate relaxations of gastrointestinal smooth muscle. It is clear, however, that NO is unlikely to be the only transmitter released by enteric inhibitory motor neurons: several other substances such as vasoactive intestinal polypeptide (VIP), or related peptides, and adenosine triphosphate (ATP) are also likely to contribute to nerve‐mediated inhibition. The identification of NO as a major inhibitory neurotransmitter to gastrointestinal smooth muscle fills an important gap in our understanding of the physiological control of motility and opens up a wide range of new experimental possibilities. It may eventually lead to the development of new drugs for motility disorders. It should be noted, however, that NO is important in the brain, in cardiovascular control, in blood cell function and in many other organ systems, suggesting that it may be difficult to achieve specific pharmacological intervention targeted on inhibitory neurotransmission in the gut, without undesirable side effects.
Vaccines against hepatitis A and B
Authors: HILLEMAN M. R. , CALANDRA G. B. , HESLEY T. M. , NALIN D. R. , RYAN J. L. , WEST D. J.
Published: March 2008

Hepatitis B virus infection is preventable by vaccine and the correlate of immunity is the induction of antibody. The 2.5 μg antigen per dose of H‐B‐VAX II given in appropriate regimens is adequate to immunize normal newborn infants and children up to 11 years of age. A 5 μg dose may be needed to protect newborn infants born to mothers who are carriers of hepatitis B infection and should be used when the carrier status is either positive or is unknown. The immune response in newborn infants is usually of lower titre than in infants who are 2–3 months of age or older. The level of protection afforded in otherwise healthy individuals by plasma‐derived vaccine is high and lasts for longer than 7 years, even though the level of circulating antibody may have declined to a less than detectable amount. A similar pattern of antibody decline follows administration of recombinant vaccine. The mechanism for sustained protection is in long‐term immunological memory with rapid recall of antibody production on exposure to the virus in nature. Administration of hepatitis B vaccine will be simplified by combination with DPT and poliomyelitis vaccines in single‐dose formulations that are under current development.

An experimentally killed hepatitis A virus vaccine prepared by formaldehyde inactivation of attenuated live virus purified from infected MRC‐5 cell cultures induces rapid and high level antibody response when the vaccine is given in as little as 100 ng of antigen per dose and in two‐ or three‐dose regimens. The vaccine is highly protective when assayed in challenge studies in animals and the levels of antibodies achieved are far in excess of those provided by immune globulin when used for passive protection in humans. Field investigations to demonstrate protective efficacy against natural challenge in human beings have been in progress and protective efficacy has been established.
Development of portal vein invasion and its outcome in hepatocellular carcinoma treated by transcatheter arterial chemo‐embolization
Authors: CHEN SHINN‐CHERNG , HSIEH MING‐YUH , CHUANG WAN‐LONG , WANG LIANG‐YEN , CHANG WEN‐YU
Published: March 2008

Abstract Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. One serious complication is the invasion of the portal vein. To investigate the new invasion of the portal vein in HCC following treatment by transcatheter arterial chemo‐embolization (TACE), 124 patients with HCC were screened by ultrasound, computed tomography and angiography. Fifteen patients were diagnosed with portal vein invasion (PVI) during the initial examination and were excluded from the study. Of the remaining 109 patients, 18 developed PVI. Fourteen were male and four were female. None of these 18 patients completely responded to TACE treatment and all were in recurrence. The median time for appearance of PVI after the first TACE was 212 days. The median interval between PVI and the last negative ultrasound examination was 100 days. Both were correlated with the degree of PVI. The only significant factor affecting the time until the appearance of PVI was the TACE treatment. After the development of PVI, eight patients continued with the TACE treatment, and three of these patients were also treated with portal vein local chemotherapy. The regression of PVI was observed in two patients. The median survival time after the discovery of PVI was 129 days. Factors affecting the survival time were performance state, Pugh classification, sex, the area of tumour invasion and continued treatment.
Limitations of endoscopic haemostasis by ethanol injection and surgical management for bleeding peptic ulcer
Authors: ISHIKAWA MASASHI , KIKUTSUJI TORU , MIYAUCHI TAKAYUKI , SAKAKIHARA YUKIO
Published: March 2008

Abstract Two hundred and fifty‐three patients with bleeding peptic ulcer underwent therapeutic endoscopy using local ethanol injection and were evaluated to determine the need for surgery and outcome. Permanent endoscopic haemostasis was achieved in 178 (70.4%) cases. Pulsatile arterial bleeding in ulcers and shock on admission (respectively, P < 0.01, P < 0.05) were significantly more frequent in patients with unsuccessful endoscopic treatment. Postoperative stay was significantly longer (P < 0.05) for patients with bleeding peptic ulcer than for patients requiring surgery for intractable ulcer without bleeding. Surgery was recommended if three attempts at endoscopic treatment did not achieve permanent haemostasis. The need for more than three such treatment sessions and the presence of a large excavated ulcer with an exposed vessel in an elderly patient were considered to indicate the necessity for surgery. Surgical procedures to which the operator is accustomed and intensive management were recommended for emergency cases to optimize the likelihood of survival.
A possible role for bile acid in the control of methanogenesis and the accumulation of hydrogen gas in the human colon
Authors: FLORIN TIMOTHY H. J. , JABBAR IBTISSAM A.
Published: March 2008

Abstract This study investigated a possible role for primary bile acid in the control of methanogenesis in the human colon. Production of hydrogen and methane was measured in anaerobic faecal cultures derived from faeces of six ‘non‐methanogenic’ and three methanogenic healthy humans. Using a sensitive technique for gas measurement, methane was detected in all faecal cultures, including those from ‘non‐methanogenic’ humans. Bile acid inhibited methanogenesis in a dose‐response fashion in the in vitro‘non‐methanogenic’ and methanogenic faecal cultures. Inhibition was significant at bile acid concentrations > 0.05%. Methanogenesis correlated with methanogen (methanogenic bacteria) numbers. If this inhibition occurs in vivo, then it would explain much of the epidemiology of non‐methanogenesis in humans. From an analysis of net hydrogen production by the faecal cultures, it is inferred that bile acid inhibits other hydrogen‐consuming bacteria in addition to methanogens. These in vitro data suggest a major role for bile acid in the accumulation of hydrogen gas in the colon. Possible links between bile acid induced accumulation of gas and irritable bowel syndrome are discussed.
Relationships between the severity of cirrhosis and haemodynamic values in patients with cirrhosis
Authors: MENG HONG‐CHIANG , LIN HAN‐CHIEH , TSAI YANG‐TE , LEE FA‐YAUH , LIAO DONG‐MING , HSIA HSIAO‐CHUNG , LIN WEN‐JEH , CHANG TING‐TSUNG , LAY CHII‐SHYAN , WANG SUN‐SANG , LEE SHOU‐DONG , LO KWANG‐JUEI
Published: March 2008

Abstract The relationship between the severity of cirrhosis and systemic and hepatic haemodynamic values was evaluated in 193 patients with cirrhosis, most of whom were diagnosed with post‐necrotic cirrhosis. It was found that the hepatic venous pressure gradient and cardiac output in Pugh's A patients (13.6 ± 4.8 mmHg and 6.2 ± 1.6 L/min, mean ± s.d.) were significantly lower than in both Pugh's B (16.8 ± 4.3 mmHg and 7.3 ± 2.1 L/min) and Pugh's C (18.8 ± 5.5 mmHg and 7.4 ± 2.3 L/min) patients (P < 0.01), respectively. In contrast, the systemic vascular resistance in Pugh's A patients (1232 ± 369 dyn/s per cm5) was significantly higher than in both Pugh's B (1016 ± 345 dyn/s per cm5) and Pugh's C (935 ± 234 dyn/s per cm5) patients (P < 0.01), respectively. Additionally, not only was there a positive correlation found between Pugh's score and cardiac output and hepatic venous pressure gradient, but a negative correlation was found between Pugh's score and systemic vascular resistance. It was also confirmed that the degree of portal hypertension and the hyperdynamic circulation were more severe in patients with ascites than in those without ascites. However, there were no statistically significant differences in hepatic venous pressure gradient among patients with F1, F2 and F3 esophageal varices (15.7 ± 4.0, 17.0 ± 4.8 and 18.0 ± 4.8 mmHg, respectively). It is concluded that in those patients with cirrhosis, the severity of cirrhosis is closely related to the degree of the hyperkinetic circulatory state and portal hypertension.
Long‐term prognosis and prognostic factors of liver cirrhosis in the 1980s
Authors: SUGIMURA TAKASHI , TSUJI YUJI , SAKAMOTO MAKI , KOTOH KAZUHIRO , FUKUTOMI TAKAYOSHI , SAKAI HIRONORI , SAKAMOTO SHIGERU , AKAZAWA KOUHEI , NOSE YOSHIAKI , NAWATA HAJIME
Published: March 2008

AbstractThe prognosis of 174 patients with cirrhosis during the 1980s (1981–89) was analysed. The estimated survival rates were 87.3% in 3 years and 68.5% in 5 years. During the follow‐up period, 58 patients died: 20 of hepatocellular carcinoma (37.7%); 11 of hepatic failure (20.8%); eight of gastrointestinal bleeding (15.1%); and 14 of other causes (26.4%). Multivariate analysis revealed that serum albumin, indocyanine green retention rate at 15 min and white blood cell count were significantly associated with prognosis. The results were also compared to our previous study covering the 1970s (1971–80). The estimated survival rate was significantly improved compared to that during the 1970s (54.3% in 5 years,P< 0.001). In the 1980s, hepatic failure mortality significantly decreased (P< 0.01), and non‐liver‐related mortality significantly increased (P< 0.05). In summary, the prognosis of cirrhosis has improved in recent years, and changes of death cause and prognostic factors were observed. It was concluded that to evaluate the severity and prognosis of cirrhosis, new indices and appropriate classification were necessary.
Two cases of Caroli's disease: Diagnosis and management
Authors: BURT MICHAEL J. , CHAMBERS STEPHEN T. , CHAPMAN BRUCE A. , STRACK MATTHEW F. , TROUGHTON W. DAVID
Published: March 2008

Abstract Caroli's disease is an uncommon congenital malformation involving the intrahepatic bile ducts. This paper reports two cases presenting with biliary tract infection. Diagnosis was established by non‐invasive imaging and cholangiography. The infecting organisms were cultured from bile obtained by percutaneous aspiration and the results were used to direct antimicrobial therapy. The role of antibiotics and other management options in preventing recurrent infection is discussed.
Laparoscopic observation of retroperitoneal cystic lymphangioma
Authors: TAKEUCHI Y. , FUJINAMI S. , KITAGAWA S. , SHIRO T. , FUJII T. , FUKUI Y. , KAWASHIMA Y. , KUBOTA Y. , SHIOZAKI Y. , INOUE K. , KITADE H. , HIRAMATSU Y.
Published: March 2008

Abstract A case of retroperitoneal cystic lymphangioma observed laparoscopically is reported. In a 60 year old asymptomatic male patient, an 8 cm multi‐loculated cystic lesion was detected incidentally near the splenic hilum with ultrasonography. Endosonography, computed tomography and magnetic resonance imaging revealed the lesion with thin wall and clear fluid.

Laparoscopy showed a thin‐walled cyst with smooth surface, and straw‐coloured clear fluid was observed through the wall. These findings suggested benign aetiology, and seemed to be characteristic of cystic lymphangioma. The tumour was resected, and microscopic examination showed proliferated lymph channels intespersed by lymph follicles. Diagnosis of cystic lymphangioma was established. Laparoscopy seems a useful pre‐operative method.
Role of fibronectin and complement in immunopathogenesis of acute and subacute hepatic failure
Authors: IRSHAD M. , ACHARYA S. K. , JOSHI Y. K. , TANDON B. N.
Published: March 2008

Abstract The present study describes the plasma levels of soluble fibronectin (FN), C3d, the breakdown product of C3 complement and Ba, the breakdown product of properdin factor B, in 30 patients of uncomplicated acute viral hepatitis (AVH), 64 patients of fulminant hepatic failure (FHF) and 29 patients of subacute hepatic failure (SAHF) with different hepatitis viral infectionse. Aetiological analysis of these patients demonstrated hepatitis B, hepatitis C and hepatitis non‐A, non‐B, non‐C (NANB‐NC) infections in 6.7, 13.3 and 80% cases, respectively, of the AVH group; 18.8, 42.2. and 39.0% cases, respectively, of the FHF group; and 31.0, 34.5 and 34.5% cases of the SAHF group. None of them had hepatitis A infection. The analysis of data showed that the plasma FN level was significantly reduced in patients with FHF and SAHF as compared to AVH patients and healthy persons. Fibronectin levels in AVH was comparable to that in the healthy group. Further, the FN level was not dependent on the nature of aetiological virus. The level of C3d in plasma was significantly high in all patients of FHF and SAHF, irrespective of their viral aetiology, compared to the AVH group and the healthy group. Like FN, the C3d level was comparable in the AVH and healthy groups. However, the Ba level was comparable to the normal value in all types of infections including the AVH, FHF and SAHF groups. These findings were used to explain the possible roles of fibronectin and complement in the immunopathogenesis of liver injury in patients of acute liver failure of viral aetiology.
Mass screening for hepatocellular carcinoma: Experience in Hokkaido, Japan
Authors: MIMA SATOAKI , SEKIYA CHIHIRO , KANAGAWA HIROSHI , KOHYAMA HARUKAZU , GOTOH KENICHIRO , MIZUO HITOSHI , IJIRI MASAHIRO , TANABE TOSHIO , MAEDA NOBUO , OKUDA KUNIO
Published: March 2008

Abstract Mass screening for liver cancer based mainly on abdominal ultrasound was begun in major cities of Hokkaido, Japan, in November 1981, to enable early detection and treatment of hepatocellular carcinoma (HCC). Serum alpha‐fetoprotein levels were also measured to minimize false negative studies. Examinees included those who sought liver disease screening as well as high risk individuals: hepatitis B surface antigen carriers and those with a past or current liver disease, history of blood transfusion, family history of liver cancer, and more recently those with positive anti‐hepatitis C antibodies. The examination was carried out on each Saturday and Sunday as one round, and by February 1992 48 rounds had been performed. A total of 8090 individuals were investigated, and HCC was detected in 91 with a detection rate of 1.12%. This rate was 1.6% among 5684 individuals who were selected for high risk. Cumulative rates of survival among these patients were 79.0% at 1 year, 43.8% at 3 years, 19.3% at 5 years and 15.4% at 7 years. These survival rates were comparable with those for the patients with HCC diagnosed during follow‐up of chronic liver disease and treated at our hospital. The cost for detecting one HCC patient in this programme was ¥ 2 660 000 (∼US$25 000), which was less than those for some other types of cancer in a similar setting. Considering the high detection rate in this programme, we feel that similar programmes should be encouraged and supported.
Detection of interferon‐alpha expression by PCR in patients with chronic hepatitis C and hepatitis non‐A, non‐B
Authors: BRANDT EVELYN R. , DEVENISH RODNEY J. , HERTZOG PAUL J. , DUDLEY FRANCIS J. , LINNANE ANTHONY W.
Published: March 2008

Abstract The polymerase chain reaction (PCR) was used to examine expression of interferon‐alpha (IFN A) genes in general and the expression of messenger RNA (mRNA) encoding the subtypes IFN‐α‐2 and IFN‐α‐4 in blood and liver biopsy samples from patients with chronic hepatitis C or hepatitis non‐A, non‐B (HC/HNANB) infection entered into a trial of IFN‐α‐2a therapy. Peripheral blood mononuclear cells (PBMC) from healthy controls and HC/HNANB infected patients were studied for their capacity to produce transcripts encoding IFN‐α after stimulation with Sendai virus. Expression at the level of mRNA for IFN A and the subtypes IFN A2 and A4 was detected in both controls and HC/HNANB infected patients PBMC and no significant difference was seen in expression of IFN A transcripts or level of total IFN‐α secreted into culture supernatants between controls and patients. Interferon A, and specifically IFN A2 and IFN A4 transcripts were detected in a high proportion of liver biopsies from patients with HC/HNANB infection. The presence of IFN A mRNA (and specifically IFN A2 and IFN A4) showed no correlation to histological improvement nor response to therapy. The use of PCR to detect those IFN A genes that are not expressed, thereby identifying subtypes that may be lacking, could be the key to the choice of IFN‐α subtypes that are used for effective therapy.
Prevalence of hepatitis C virus markers in Sri Lankan patients with alcoholic cirrhosis
Authors: SILVA H. J. DE , VITARANA T. , RATNATUNGA N. , BRESCHKIN A. , WITHANE N. , KULARATNE W. N. S.
Published: March 2008

Abstract A high prevalence of antibodies against hepatitis C virus (HCV) has been reported in patients with alcoholic cirrhosis. There are, however, doubts regarding the specificity of the first generation anti‐HCV antibody assays used. We prospectively investigated HCV status in 47 Sri Lankan patients with alcoholic cirrhosis. A first generation assay (Ortho HCV enzyme‐linked immunosorbent assay [ELISA]) and two second generation tests (Abbott HCV enzyme immunoassay and United Biomedical Incorporated HCV enzyme immunoassay) were used. Positive results were confirmed by the second generation recombinant immunoblot assay (RIBA 2). Of the 47 patients (46 males, mean age 41.7 years), 17 (36.2%) had previously had one or more blood or plasma transfusions. Seven (14.9%) of the samples were positive for anti‐HCV antibodies using the Ortho‐HCV ELISA, but only one (2.1%) sample was positive when tested with the second generation assays. The positive result was confirmed by RIBA 2. The prevalence of HCV in the patients was low despite many of them being exposed to blood or blood products. Hepatitis C virus, therefore, may not be an important pathogenic factor in alcoholic cirrhosis in Sri Lanka.
Glucose transport and hypoxia–reoxygenation injury in the perfused rat liver
Authors: COUTEUR DAVID G. LE , RIVORY LAURENT P. , POND SUSAN M.
Published: March 2008

Abstract During liver transplantation, oxidative stress occurs during hypoxia and reoxygenation of the donor organ. Chemical oxidative stress impairs cell membrane transport. Therefore, in this study the influence of hypoxia and reoxygenation on hepatocellular membrane transport was investigated. Specifically, glucose transport was studied in the perfused rat liver using the multiple indicator‐dilution technique. First, it was observed that in normal rat livers, glucose transport was rapid but saturable (Km48 ± 10 mmol/L and Vmax9.4 ± 0.9 μmol/s per g of liver). To simulate hypoxia and reoxygenation, livers were perfused for 30 min with nitrogen‐saturated buffer and then with oxygen‐saturated buffer for 20 min. The livers from fed rats were protected from hypoxia‐reoxygenation injury whereas those from fasted rats were highly susceptible to injury as determined by lactate dehydrogenase release. After reoxygenation, the rate of glucose influx decreased significantly by ∼50% in the fasted livers (P < 0.001) but was unaffected in the fed livers. This impairment of the hepatocellular transport of glucose, which could be secondary to oxidative injury to the hepatocyte membrane, has implications for the function of donor livers that have sustained hypoxia‐reoxygenation (‘preservation') injury during transplantation.
Prolonged bleeding time in cirrhotic patients: Relationship to peripheral vasodilation and severity of cirrhosis
Authors: HSU WAN‐CHING , LEE FA‐YAUH , LEE SHOU‐DONG , TSAI YANG‐TE , LIN HAN‐CHIEH , LIN REN‐SHIN , MENG HONG‐CHIANG , WANG TEH‐FANG , WANG SUN‐SANG , LO KWANG‐JUEI
Published: March 2008

Abstract A prolonged bleeding time (>540 s), measured with a Simplate single template device, was found in 0% of 50 patients with chronic hepatitis and 38% of 154 cirrhotic patients. Cirrhotic patients with a prolonged bleeding time (n= 59) had lower platelet counts (P < 0.001) and a longer prothrombin time (P < 0.001) and activated partial thromboplastin time (P < 0.001) compared with cirrhotic patients with a normal bleeding time (n= 95). A weak but significant negative correlation existed between the bleeding time and platelet count in cirrhotic patients (n= 154, r= ‐0.3668, P < 0.001). Patients with decompensated cirrhosis had a longer bleeding time in comparison to patients with compensated cirrhosis (621±39 vs 478 ± 27 s, respectively, P < 0.01). The prolonged bleeding time was also discovered in 25% of 83 cirrhotic patients with a platelet count >80 × 109/L and a prothrombin time < 17 s (usually taken as safe limits for invasive procedures). Twenty‐seven of the 83 cirrhotic patients received a haemodynamic study by Swan‐Ganz catheterization. A lower systemic vascular resistance was found in cirrhotic patients with an abnormal bleeding time than in cirrhotic patients with a normal bleeding time (844 ± 57 vs 1171 ± 60 dyne·s·cm−5, respectively, P < 0.001), whereas both groups had similar hepatic venous pressure gradient (16.2 ± 1.2 vs 18.1 ± 1.4 mmHg, respectively, P > 0.05). There was a significant negative correlation observed between systemic vascular resistance and bleeding time in cirrhotic patients with a platelet count >80 × 109/L and a prothrombin time < 17 s (n= 27, r= ‐0.63, P < 0.001). These results demonstrate that prolonged bleeding time is common in patients with cirrhosis. Peripheral vasodilation is probably an important factor in addition to platelet counts and the severity of liver disease in determining the bleeding time in cirrhosis.
Analysis of nucleotide sequences of hepatitis C virus isolates from husband–wife pairs
Authors: SETOGUCHI YOICHI , KAJIHARA SUSUMU , HARA TOSIYA , MOTOMURA MITSUAKI , MIZUTA TOSIHIKO , WADA IKUKO , YAMAMOTO KYOSUKE , SAKAI TAKAHIRO
Published: March 2008

Abstract To identify the route of hepatitis C virus (HCV) transmission, we investigated the sexual transmission of HCV by examining HCV markers among spouses of patients with chronic liver disease (CLD) due to HCV. Of 83 spouses, 14 (16.9%) had elevated serum aspartate aminotransferase or alanine aminotransferase, 20 (24.1%) had detectable anti‐HCV antibodies, and 17 (20.5%) had measurable HCV‐RNA in serum. However, the seropositivity rate of anti‐HCV antibodies (24.1%) of patients’ spouses was not significantly higher than that (15.4–27.5%) of an unselected population in the same district. Ten patient‐spouse pairs underwent nucleotide sequence analysis of the HCV core and envelope genes. Overall the sequence homology of 10 couples (91.1%) was not significantly higher than that of 10 randomly chosen unrelated pairs (88.2%). As reported earlier, in an age and sex matched case‐control study of HCV transmission, a history of surgery is a prominent HCV risk factor. These results suggest that sexual transmission of HCV is rare.