bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospitals without walls: A journey through the health‐care system
Authors: Cox Helen , Cox Douglas
Published: March 2003

The paper describes aspects of a journey through the health‐care system following a domestic accident. The journey commenced in the accident and emergency department and, over a 3 month period, traversed the operating theatre, intensive care and an orthopaedic ward before moving into a Hospital in the Home programme and community health and district nursing services. The paper explores the experiences of the accident victim, a 56‐year‐old man, and his wife who is an experienced nurse and university lecturer. The paper supports the ‘seamless delivery’ concept of integrated care while, at the same time, sounding notes of caution. The principal messages in this paper are about the relationships that nurses build with patients and their families over long periods of care, the paradoxical sense of ‘outsideness’ that can occur when the home becomes medicalized and the importance of the home as a healing environment.
Recommendations for culturally sensitive nursing care
Authors: Josipovic Patricia
Published: March 2003

Australia’s health care clientele reflects the diversity of this multicultural society. Patients and health care professionals have expectations of health care which may not be met to their satisfaction or needs. The perceived inadequacies of and increased demands on the Australian health care system are reflected in the literature and by active political lobbying. Thus, there is an urgent need to investigate how the health care system can be improved and how recommendations from research can be put into place. One mechanism that may provide some of the changes required is to use the skills, experience and qualifications of culturally and linguistically diverse nurses. This paper, which is based on a descriptive ethnographic research project, will provide insight for utilizing this valuable and available resource, and how nursing education curricula can be modified to adequately incorporate transcultural nursing practices, so that nurses can meet the challenges of caring for Australia’s multicultural population.
Perceptions of registered nurses working with assistive personnel in the United Kingdom and the United States
Authors: McLaughlin Frank E , Barter Marjorie , Thomas Sue A , Rix Gary , Coulter Margaret , Chadderton Hugh
Published: March 2003

This study examines registered nurse perceptions of their role in acute care hospitals that use nursing care assistants (NCA) and unlicensed assistive personnel (UAP). Also studied was registered nurse (RN) satisfaction with nursing care assistants and unlicensed assistive personnel in the United Kingdom (UK) and the United States of America (USA). The purpose of this study is to assist RNs and managers in the re‐design of health‐care delivery systems by investigating:

1. The differences and similarities of registered nurses in the UK and the USA in the perceptions of changes in the RN role when working with nursing care assistants or unlicensed assistive personnel.

2. The differences between and similarities of registered nurses in the UK and the USA in perceptions of NCA and UAP abilities to perform delegated duties, to communicate pertinent clinical information and to provide more time for professional nursing activities.

Registered nurse perceptions in the UK were compared with the findings of a previous study of RN role changes and satisfaction in the USA. Registered nurses in the UK did not perceive a profound change in their role when working with UAP and were more satisfied with their use than were RNs in the USA.
Nursing staff anxiety versus smoking habits
Authors: Tselebis Athanassios , Panaghiotou Aspasia , Theotoka Ilia , Ilias Ioannis
Published: March 2003

The aim of this study was to assess smoking habits versus anxiety levels of 114 female nurses. The Spielberger State‐Trait Anxiety Inventory Scale (STAI, Questions 21–40) was used. Current smokers (n = 52) had the highest levels of anxiety (STAI score: mean ± SD, 43.04 ± 8.48) compared to non‐smokers (n = 30), and ex‐smokers (n = 32) (38.94 ± 6.45 and 36.56 ± 6.62, respectively; P < 0.02). Differences in STAI scores were greater between non‐smokers and ex‐smokers (P < 0.01), while the STAI scores of current smokers were positively correlated with their per day quota of cigarettes (Pearson’s: +0.65; P < 0.002). We concluded that even in people who are well‐acquainted with the ill‐effects of nicotine abuse, smoking habits persist and are correlated with levels of anxiety. Apparently the (perceived) stress‐relieving effects of nicotine outweigh anxiety of nursing staff. Preventive programs, if based exclusively on information on the effects of smoking on health, seem to be ineffective. Alternatively, techniques aimed at the relief of anxiety may yield better results.
Early adolescents’ HIV‐related knowledge, attitudes and behaviour in Finland
Authors: (Healthcare) Ulla Muinonen MSc , PhD Tarja Suominen , PhD Maritta Välimäki , Lohrmann Christa , MA Ian Peate
Published: March 2003

Finland had a relatively low rate of HIV infection during the first 17 years of the epidemic, which began in 1980. Similar to other developed countries around the world, information about the infection has been readily available, and this helped to reduce the occurrence of HIV contagion, particularly among adolescents, a group that is responsible for 50% of HIV infections worldwide. This small‐scale study investigated HIV‐related knowledge, attitudes, and behaviour among a group of 171 youths aged 13–16 years in suburban schools in southern Finland. Knowledge levels were relatively low and the disease was somewhat stigmatized, but homosexuality was less stigmatized than in other developed countries. The results suggest that Finnish adolescents need to be better informed about HIV and AIDS. Schools and school nurses could play a crucial role in providing information about this incurable disease.
A practical guide to the implementation of an effective incident reporting scheme to reduce medication error on the hospital ward
Authors: Webster Craig S , Anderson David J
Published: March 2003

This paper discusses an anonymous incident reporting scheme to reduce drug administration error on the hospital ward, as part of an effective, non‐punitive, systems‐focused approach to safety. Drug error is costly in terms of increased hospital stay, resources consumed, patient harm, lives lost and careers ruined. Safety initiatives that focus, not on blaming individuals, but on improving the wider system in which personnel work have been adopted in a number of branches of health care. However, in nursing, blame remains the predominant approach for dealing with error, and the ward has seen little application of the systems approach to safety. Safety interventions founded on an effective incident scheme typically pay for themselves in terms of dollar savings arising from averted harm. Recent calls for greater health‐care safety require finding new ways to make drug administration safer throughout the hospital, and the scope for such safety gains on the hospital ward remains considerable.
Quality of life of elderly Japanese patients with glaucoma
Authors: Uenishi Yoko , Tsumura Hisako , Miki Tokuhiko , Shiraki Kunihiko
Published: March 2003

To evaluate the quality of life (QOL) of elderly Japanese glaucoma patients, we performed a survey of 114 outpatients of a university eye clinic aged from 47 to 86 years. We examined 110 cases using one‐way anova, Bonferroni's multiple comparison, non‐parametric Mann–Whitney U‐test and Pearson's correlation coefficient analysis. The group with better traditional visual measures had better QOL than the group with worse visual acuity. In the elderly groups of patients, the loss of hopes for future life and its consequences caused greater reduction in QOL than did the symptoms of glaucoma. The reliability of our questionnaire was high as determined using α‐coefficients of Cronbach reliability analysis. Our questionnaire was reliable and useful for the assessment of QOL of elderly Japanese glaucoma patients.
Spatial variations of the décollement/protodécollement zone and their implications: A 3‐D seismic inversion study of the northern Barbados accretionary prism
Authors: Zhao Zhiyong , Moore Gregory F. , Bangs Nathan L. B. , Shipley Thomas H.
Published: March 2003

We conducted a 3‐D seismic inversion study to investigate spatial variations of physical properties of the décollement zone (DZ) and protodécollement zone (PDZ) under the northern Barbados accretionary prism. Significant spatial variations of physical properties were observed in the PDZ seaward of the thrust front from the inversion data. The density generally increases southward with a few localized low‐density patches. A lower density commonly corresponds to a thicker PDZ, suggesting that the paleomorphology may at least partially control the variations of the physical properties. Similar low‐density patches were also found in the DZ. These features may be inherited from those of the PDZ and enhanced after subduction through localized arrested consolidation. Under the prism toe, the density of the DZ increases landward. This trend may mainly result from shear‐induced consolidation of the DZ but may also be related to landward increasing tectonic loading. Significant north–south differences in density and, thus, porosity and strength of the PDZ, are observed and these differences may continue into the DZ. A stronger DZ is likely responsible for a larger prism taper observed in the southern area of the prism toe. The larger taper, thus more horizontal shortening, coupled with a thinner sediment sheet above the PDZ in the southern area, may cause a relative retreat of the thrust front and a pronounced change in strike of the sequence thrusts south of seismic Line 690. The north–south differences may ultimately have originated in the approach of a structurally higher segment of the Tiburon Rise. The Tiburon Rise affects regional morphology and, thus, it controls the sedimentation and physical properties of the PDZ. It may also control sediment accumulation above the PDZ. Therefore, the sedimentational change induced by the structural high of the Tiburon Rise, in turn, resulted in structural change of the prism in the southern area.
Accretion and tectonic erosion processes revealed by the mode of occurrence and geochemistry of greenstones in the Cretaceous accretionary complexes of the Idonnappu Zone, southern central Hokkaido, Japan
Authors: Ueda Hayato , Kawamura Makoto , Niida Kiyoaki
Published: March 2003

The Cretaceous accretionary complexes of the Idonnappu Zone in the Urakawa area are divided into five lithological units, four of which contain greenstone bodies. The Lower Cretaceous Naizawa Complex consists of two lithologic units. The Basaltic Unit (B‐Unit) is a large‐scale tectonic slab of greenstone, consisting of depleted tholeiite similar to that of the Lower Sorachi Ophiolite (basal forearc basin ophiolite) in the Sorachi‐Yezo Belt. The Mixed Unit of Naizawa Complex (MN‐Unit) contains oceanic island‐type alkaline greenstones which occur as slab‐like bodies and faulted blocks with tectonically dismembered trench‐fill sediments. Repeated alternations of the two units in the Naizawa Complex may have been formed by the collision of seamounts with forearc ophiolitic body (Lower Sorachi Ophiolite) in the trench. The Upper Cretaceous Horobetsugawa Complex structurally underlies the Naizawa Complex in its original configuration, and it also contains greenstone bodies. Greenstones in the MH‐Unit occur as blocks and sedimentary clasts in a clastic matrix, and exhibit depleted tholeiite and oceanic‐island alkaline basalt/tholeiite chemistry. This unit is interpreted as submarine slide and debris flow deposits. Greenstones in the PT‐Unit occur at the base of several chert‐clastic successions. Most of the greenstones are severely sheared and show normal‐type mid‐ocean ridge basalt composition. The PT‐Unit greenstones are considered to have been derived from abyssal basement peeled off during accretion. The different accretion mechanism of the greenstones in the Naizawa and Horobetsugawa complexes reflects temporal changes in subduction zone conditions. Seamount accretion and tectonic erosion were dominant in the Early Cretaceous, due to highly oblique subduction of the old oceanic crust and minimal sediment supply. Whereas, thick sediments with minor mid‐ocean ridge basalt and olistostrome accreted in the Late Cretaceous, due to near‐orthogonal subduction of young oceanic crust with voluminous sediment supply.
Overview of the geology, petrology and tectonic framework of the high‐pressure–ultrahigh‐pressure metamorphic belt of the Kokchetav Massif, Kazakhstan
Authors: Maruyama S. , Parkinson C. D.
Published: March 2003

Abstract High‐ to ultrahigh‐pressure metamorphic (HP–UHPM) rocks crop out over 150 km along an east–west axis in the Kokchetav Massif of northern Kazakhstan. They are disposed within the Massif as a 2 km thick, subhorizontal pile of sheet‐like nappes, predominantly composed of interlayered pelitic and psammitic schists and gneisses, amphibolite and orthogneiss, with discontinuous boudins and lenses of eclogite, dolomitic marble, whiteschist and garnet pyroxenite. On the basis of predominating lithologies, we subdivided the nappe group into four north‐dipping, fault‐bounded orogen‐parallel units (I–IV, from base to top). Constituent metabasic rocks exhibit a systematic progression of metamorphic grades, from high‐pressure amphibolite through quartz–eclogite and coesite–eclogite to diamond–eclogite facies. Coesite, diamond and other mineral inclusions within zircon offer the best means by which to clarify the regional extent of UHPM, as they are effectively sequestered from the effects of fluids during retrogression. Inclusion distribution and conventional geothermobarometric determinations demonstrate that the highest grade metamorphic rocks (Unit II: T = 780–1000°C, P = 37–60 kbar) are restricted to a medial position within the nappe group, and metamorphic grade decreases towards both the top (Unit III: T = 730–750°C, P = 11–14 kbar; Unit IV: T = 530°C, P = 7.5–9 kbar) and bottom (Unit I: T = 570–680°C; P = 7–13.5 kbar). Metamorphic zonal boundaries and internal structural fabrics are subhorizontal, and the latter exhibit opposing senses of shear at the bottom (top‐to‐the‐north) and top (top‐to‐the‐south) of the pile. The orogen‐scale architecture of the massif is sandwich‐like, with the HP–UHPM nappe group juxtaposed across large‐scale subhorizontal faults, against underlying low P–T metapelites (Daulet Suite) at the base, and overlying feebly metamorphosed clastic and carbonate rocks (Unit V). The available structural and petrologic data strongly suggest that the HP–UHPM rocks were extruded as a sequence of thin sheets, from a root zone in the south toward the foreland in the north, and juxtaposed into the adjacent lower‐grade units at shallow crustal levels of around 10 km. The nappe pile suffered considerable differential internal displacements, as the 2 km thick sequence contains rocks exhumed from depths of up to 200 km in the core, and around 30–40 km at the margins. Consequently, wedge extrusion, perhaps triggered by slab‐breakoff, is the most likely tectonic mechanism to exhume the Kokchetav HP–UHPM rocks.
New advances of seismic tomography and its applications to subduction zones and earthquake fault zones: A review
Authors: Zhao Dapeng
Published: March 2003

Abstract There have been significant advances in the theory and applications of seismic tomography in the last decade. These include the refinements in the model parameterization, 3‐D ray tracing, inversion algorithm, resolution and error analyses, joint use of local, regional and teleseismic data, and the addition of converted and reflected waves in the tomographic inversion. Applications of the new generation tomographic methods to subduction zones have resulted in unprecedentedly clear images of the subducting oceanic lithosphere and magma chambers in the mantle wedge beneath active arc volcanoes, indicating that geodynamic systems associated with the arc magmatism and back‐arc spreading are related to deep processes, such as the convective circulation in the mantle wedge and deep dehydration reactions in the subducting slab. High‐resolution tomographic imagings of earthquake fault zones in Japan and California show that rupture nucleation and earthquake generating processes are closely related to the heterogeneities of crustal materials and inelastic processes in the fault zones, such as the migration of fluids. Evidence also shows that arc magmatism and slab dehydration may also contribute to the generation of large crustal earthquakes in subduction regions.
Subaqueous sand blow deposits induced by the 1995 Hyogo‐ken Nanbu Earthquake, Japan
Authors: Kitamura Akihisa , Tominaga Eiji , Sakai Hideo
Published: March 2003

Abstract The 1995 Hyogo‐ken Nanbu Earthquake (Mw 6.9) occurred in the region around Kobe City and Awaji Island in south‐west Japan. Co‐seismic liquefaction caused subsidence of the land and damage to sea wall caissons on the man‐made Port Island at Kobe City. A zone 2–3 m wide behind the caissons of the northern wharf on the island subsided into the intertidal zone and a sandy deposit settled into this subsided zone. The depos‐it consists of upward‐fining sequences that are subdivided into three parts, in ascending order: graded coarse‐ to medium‐grained sand, parallel‐laminated fine‐ to very‐fine‐grained sand, and massive mud. Grain fabric analysis (employing the anisotropy of magnetic susceptibility method and microscopic measurement) of these sequences shows that there is a remarkable contrast in grain fabric between the lowest portion of the graded sand division and the laminated sand division. The former has a high q‐value (magnetic lineation/foliation) and a unimodal orientation of elongate grains in the horizontal plane, but random orientation in the vertical plane. Conversely, the latter is characterized by a low q‐value and a grain fabric in which the long axes of the grains have random orientations and are nearly parallel to the plane of deposition. This result shows that the main depositional processes changed from a combination of flow and allied processes to the force of gravity. As still water is essential for gravity to be the dominant factor in deposition, this deposit is regarded as subaqueous sand blow deposits. If this interpretation is correct, the grain fabric produced by gravity alone is a useful criterion for distinguishing between subaqueous sand blow deposits and other liquefaction‐induced deposits.
Long‐term follow up of a randomized, controlled trial on prophylactic sclerotherapy of small oesophageal varices in liver cirrhosis
Authors: Strauss Edna , Gomes S Ribeiro Maria De Fátima , Albano Armando , Honain Nadim , Maffei Jr Romeu , Caly Wanda
Published: March 2003

Background: In order to evaluate the prophylactic impact of sclerotherapy of small varices in patients with cirrhosis and no endoscopic signs suggesting risk of haemorrhage, a randomized clinical trial was performed.

Methods: Seventy‐one hospitalized patients met the inclusion criteria of diagnosis of cirrhosis with no previous bleeding and small varices. Due to exclusion criteria of: gastroduodenal ulcers (n = 5), diverticulosis (n = 1), hepatic insufficiency (n = 10), hepatocellular carcinoma (n = 4), death before randomization (n = 6), age over 70 (n = 1) and denial of consent to participate in the study (n = 1), 43 patients could be randomized, 21 for sclerotherapy and 22 for the control group. Two patients (one in each group) were lost to follow up, and another patient, although not lost, refused sclerotherapy after randomization. Ethanolamine oleate was used as the sclerosing agent. All patients were followed up for a mean time of 60 months, initially every 2 months for the first 2 years and clinical and endoscopic controls were performed each 6–12 months thereafter.

Results and Conclusions: During the first 2 years clinical assessment showed that there were five bleedings in the sclerotherapy group and none in the control group, but mortality was similar in both groups. Long‐term follow up continued to show a higher prevalence of bleeding in the sclerotherapy group but that mortality was not different from the control group.
CASE REPORT: Haemosuccus pancreaticus: A clinical challenge
Authors: Yattoo Ghulam , Khuroo Mohammad , Wani Nazir , Wani Khurshid , Bhat Fayaz
Published: March 2003

Background: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25‐year‐old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow‐up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.
Discrimination of two different clinical entities, acute‐type and subacute‐type, human fulminant hepatitis by peripheral blood lymphocyte subsets
Authors: Shimizu Takeshi , Tokushige Katsutoshi , Yamaguchi Naoko , Ishikawa Kayo , Hasegawa Kiyoshi , Yamauchi Katsumi , Hayashi Naoaki
Published: March 2003

Human fulminant hepatitis tends to be classified into two groups: acute type (A‐FH) and subacute type (S‐FH). In order to define these two clinical entities more precisely, we examined and compared peripheral blood lymphocyte subsets in A‐FH and S‐FH patients. We found that S‐FH patients had a higher prevalence of CD19+ B cells (31.1 ± 7.6% in S‐FH vs 12.7 ± 3.7% in A‐FH) and also a lower prevalence of CD3+ T cells (50.2 ± 8.7% in S‐FH vs 65.6 ± 10.5% in A‐FH). Furthermore, by examining the absolute cell numbers of these subsets, we determined that their imbalance in S‐FH was mainly due to a decrease in CD3+ T cells. Among several T cell subsets, the CD8+CD11b−T cell subset was elevated in A‐FH and decreased in S‐FH (6.1 ± 2.1% in S‐FH, 24.4 ± 5.8% in A‐FH, and 14.8 ± 7.8% in control). Serial studies of two S‐FH patients revealed that the imbalance of these lymphocyte subsets returned to their proper ratio together with the improvement of their liver injury. These results indicate that there might be a different immunological background between A‐FH and S‐FH.
An analysis of T cell antigen receptor variable β genes during the clinical course of patients with chronic hepatitis B
Authors: Sugyo Shinya , Yuh Kouichi , Nakamura Ken , Emi Kanako , Shijo Hiroshi , Iida Takeshi , Kimura Nobuhiro , Tamura Kazuo
Published: March 2003

Background: The degree of hepatocyte injury in patients with chronic hepatitis B appears consistent with the number of T cells that respond to hepatitis B virus‐related antigens.

Methods: By using a polymerase chain reation (PCR)‐based approach, we monitored a ratio of the T cell antigen receptor (TcR) variable (V) β gene families against a total TcR Vβ gene expression in the peripheral T cells obtained from five patients and four healthy controls.

Results: In the healthy controls, there was no significant change in the ratios at an interval of four or eight weeks. In contrast, several TcR Vβ families showed the significant changes in the ratios of their gene expression during the follow‐up period in all patients. No common highly fluctuated TcR Vβ, however, was found among the patients. Furthermore, there was no correlation between their changes and serum levels of alanine aminotransferase.

Conclusions: These findings suggest that the skewing of the TcR family with multiclone is the result of T‐cell responses to viral antigens in peripheral blood.
Efficacy of 1 week omeprazole or lansoprazole– amoxycillin–clarithromycin therapy for Helicobacter pylori infection in the Japanese population
Authors: Miwa Hiroto , Nagahara Akihito , Sato Kenji , Ohkura Ryuichi , Murai Toshio , Shimizu Hidetake , Watanabe Sumio , Sato Nobuhiro
Published: March 2003

Background: The effectiveness of curative therapy for Helicobacter pylori may vary according to the geographic region and patient population, thus the efficacy of each treatment regimen should be determined according to the specific patient population. However, there is no literature available concerning the efficacy of 1 week omeprazole–amoxycillin–clarithromycin (OAC) regimens for the cure of H. pylori infection in Japan.

Methods:Helicobacter pylori‐positive patients (224) with peptic ulcer disease or non‐ulcer dyspepsia were randomized to receive one of three different omeprazole or lansoprazole–amoxycillin– clarithromycin (PPI/AC) regimens for 7 days: (1) OAC 20 regimen (n = 76), omeprazole (OPZ) 20 mg daily, amoxycillin (AMOX) 500 mg t.d.s. and clarithromycin (CAM) 200 mg b.d.; (2) LAC 30 regimen (n = 73), Lansoprazole (LPZ) 30 mg daily, AMOX 500 mg t.d.s. and CAM 200 mg b.d.; and (3) OPZ 40 regimen (n = 75), OPZ 20 b.d., AMOX 500 mg t.d.s. and CAM 200 mg b.d. Cure of the infection was determined by the [13C]‐urea breath test, 1 month after completion of the treatment.

Results: Intention‐to‐treat based cure rates for OAC 20, LAC 30 and OAC 40 regimens were 75.0% (95% CI, 64–84%), 82.2% (95%, CI 72–90), and 80.0% (95% CI, 69–88), respectively and per‐ protocol based cure rates of these regimens were 79.2% (95% CI, 68–88%), 83.3% (95%, CI 73–91), and 83.1% (95% CI, 72–91%), respectively. Adverse effects, which included diarrhoea, glossitis or skin rash, were reported by 26.1% of the patients. However, these were mild and did not affect compliance.

Conclusion: One week PPI/AC regimens for H. pylori infection with smaller proton pump inhibitors and antimicrobial dosages compared to regimens used in Western countries were revealed to provide sufficient cure rate (more than 80% by ITT analysis) with mild adverse effects in the Japanese population.
Highly enhanced fucosylation of serum glycoproteins in patients with hepatocellular carcinoma
Authors: Naitoh Akira , Aoyagi Yutaka , Asakura Hitoshi
Published: March 2003

Background: We recently reported that the measurement of Lens culinaris agglutinin‐reactive species of α‐fetoprotein (ΑFP), alpha‐1‐antitrypsin (AAT) and transferrin (TF) is useful for the diagnosis of hepatocellular carcinoma (HCC) and that the molecular basis for this reactivity is fucosylation at the innermost N‐acetylglucosamine residue of a biantennary sugar chain. However, the precise relationship of the fucosylation of AFP, AAT and TF in patients with HCC and liver cirrhosis is not fully understood. The aim of this study is to delineate the relationship of the fucosylation between these three glycoproteins in HCC.

Methods: Three hundred and thirty‐four patients with HCC were referred to our university hospital from 1987 to 1997. An increase in serum AFP (> 20 ng/mL) was observed in 233 (69.8%) patients with HCC. From these 233 patients with AFP‐producing HCC, 60 serum samples were randomly selected and used in the present study. As a reference, samples from 60 patients with liver cirrhosis, in which 30 had increased AFP, were used. Lens culinaris agglutinin (LCA)‐reactive species were determined by crossed immunoaffinoelectrophoresis (CIAE). The contents of the fucosylated biantennary chain of purified AAT and TF samples were determined as pyridylamino derivatives of each oligosaccharide with high‐performance liquid chromatography (HPLC).

Results: There was a highly significant correlation between LCA‐reactive species by CIAE and pyridylamino‐fucosylated biantennary sugar chain by HPLC in both AAT and TF. Lens culinaris agglutinin‐reactive species of AFP, AAT and TF in HCC were significantly higher than those in liver cirrhosis. A highly statistically significant positive correlation of fucosylated glycans was observed between AAT and TF in both HCC and liver cirrhosis, but not between AFP and AAT or between AFP and TF. Accordingly, the present results indicate that highly enhanced fucosylation of serum glycoproteins was found in HCC compared with liver cirrhosis and that the combination of measurements of fucosylated AFP with AAT or TF were useful for the diagnosis of HCC.
Evaluation of endoscopic ultrasonography as an indicator for surgical treatment of gastric cancer
Authors: Fujino Yasuhiro , Nagata Yutaka , Ogino Kazunori , Watahiki Hajime
Published: March 2003

Background and Methods
: Clinicopathological analysis of 346 patients with gastric cancer was made retrospectively and new criteria for the indication of a limited operation using endoscopic ultrasonography (EUS) was developed. Suggested new criteria for selecting gastric cancer patients for the limited operation were: (i) the cancer is located in the mucosa and the lymph nodes are not involved as indicated by EUS examination; (ii) the maximum size of the tumour is less than 2.0 cm; (iii) there are no multiple gastric cancers or simultaneous abdominal cancers; and (iv) the mucosal cancer of elevated type less than 2.0 cm is excluded because there are good indications for endoscopic mucosal resection.

Results and Conclusions
: We applied these new criteria to 262 patients and found that the patients who had limited operation had the same prognosis and a better quality of life compared with patients who had the conventional operation.

©1999 Blackwell Science Asia Pty Ltd
Limitations of imaging diagnosis for small hepatocellular carcinoma: Comparison with histological findings
Authors: Horigome Hideo , Nomura Tomoyuki , Saso Katsuhisa , Itoh Makoto , Joh Takashi , Ohara Hirotaka
Published: March 2003

Background and Aims
: The purpose of this study was to clarify the value and limitation of imaging modalities for diagnosing small hepatocellular carcinoma (HCC).

Methods
: Nodules (n = 207) with diameters of 20 mm or less detected by periodic ultrasonography and computed tomography in 139 patients with chronic liver disease were investigated with digital subtraction angiography (DSA) and magnetic resonance imaging (MRI). These findings were compared with histological findings.

Results
: Histological diagnoses were adenomatous hyperplasia (AH, n = 27), well‐differentiated HCC (n = 99), moderately differentiated HCC (n = 79) and poorly differentiated HCC (n = 2). We compared two groups: group A (n = 62), nodules of 10 mm diameters or less; and group B (n = 145), nodules 11–20 mm. Adenomatous hyperplasia accounted for approximately 30% of group A, but was difficult to diagnose with imaging modalities alone. We diagnosed those nodules showing hypervascular staining on DSA or hyperintensity on MRI T2‐weighted images as HCC. Imaging alone was sufficient to diagnose HCC in 58% of the well‐differentiated nodules and 87% of the moderately and poorly differentiated nodules (P < 0.01). It was possible to diagnose HCC by imaging alone in 60% of all nodules or 45% of group A and 68% of group B (A vs B, P < 0.005).

Conclusions
: With decreasing differentiation and increasing diameter of nodules, the use of imaging modalities to diagnose HCC improved. Tumour biopsy was required to diagnose 55% of the cases in group A and 32% of the cases in group B.

© 1999 Blackwell Science Asia Pty Ltd
Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O‐ring ligation
Authors: Yoshida Tomoharu , Harada Toshiya , Shigemitsu Toshinori , Takeo Yoshifumi , Miyazaki Seiji , Okita Kiwamu
Published: March 2003

Background: Cyanoacrylate injection is highly effective and is regarded as the treatment of choice in bleeding gastric varices in Europe, but intravenous injection of cyanoacrylate is not allowed in the USA and Japan because it may cause embolisms in other organs. Accordingly, we developed a new endoscopic combined treatment of endoscopic management of gastric varices using a detachable snare (EVLs) and simultaneous endoscopic sclerotherapy and O‐ring ligation (EISL) (i.e. EVLs + EISL), and we prospectively evaluated its efficacy and safety.

Methods: Gastric varices were ligated with the loop of a detachable snare that opened to a diameter of 4 cm (EVLs). Then the residual varices around the ligated portion were sclerosed by ethanolamine oleate and the injected vessel was ligated using a pneumo‐activated EVL device (EISL). The EVLs + EISL was performed in 35 patients: on an emergency basis in eight patients, on an elective basis in six patients and as primary prophylaxis in 21 patients. Liver function was classified as Child–Pugh class A in 12 patients, class B in 12 patients and class C in 11 patients.

Results: Endoscopic disappearance of gastric varices was obtained in 97.1% of the patients and they regressed in all patients. Haemostasis was achieved in all eight emergency cases. The 2‐year cumulative non‐recurrence rate was 85%, the 2‐year cumulative non‐bleeding rate was 92% and the 2‐year cumulative survival was 80%. No patients died of bleeding from gastric varices. There were no serious short‐term complications, such as haemorrhage, gastro‐oesophageal perforation, ileus, or renal impairment.

Conclusion: Combined EVLs + EISL appears to be a useful treatment for gastric varices due to its safety and good clinical outcome.
The haemochromatosis gene: A co‐factor for chronic liver diseases?
Authors: George Dk , Powell Lawrie W , Losowsky Ms
Published: March 2003

There is increasing evidence that hepatotoxins, such as alcohol and the hepatitis viruses, act as co‐factors in causing hepatic fibrosis and cirrhosis. For example, alcohol aggravates the hepatic damage produced by iron in hereditary haemochromatosis. We present evidence that the reverse is also true, that is, that iron loading of mild to moderate degree due to heterozygosity or homozygosity for the haemochromatosis genetic mutations acts as a significant hepatotoxin aggravating hepatic damage from other causes of liver disease. These include non‐alcoholic steatohepatitis, chronic hepatitis C, porphyria cutanea tarda and possibly primary liver cell cancer. However, any additional hepatotoxic effect is due to the hepatic iron concentration and not the mutations in the haemochromatosis genes.
C ASE R	EPORT: Dramatic response to lamivudine therapy following corticosteroid priming in chronic hepatitis B
Authors: Liaw Yun‐Fan , Chien Rong‐Nan
Published: March 2003

A 21 year‐old male patient with chronic hepatitis B was treated with lamivudine 150 mg daily after withdrawal of a short course of oral prednisolone (30 mg daily for 3 weeks, 15 mg daily for 1 week). Serum hepatitis B virus (HBV)‐DNA increased during prednisolone pretherapy and serum alanine aminotransferase (ALT) was increasing after withdrawal of prednisolone. Clearance of HBV‐DNA with hepatitis B e antigen seroconversion and ALT normalization occurred within 2 months after starting lamivudine therapy. If this dramatic response to lamivudine therapy after corticosteroid priming is confirmed by further studies, the regimens used in this particular case might become a powerful therapeutic tool for chronic HBV infection.
Molecular biology of gastric carcinoma: From laboratory to bedside
Authors: Chan Annie On‐On , Luk John Mc , Hui Wai‐Mo , Lam Shiu‐Kum
Published: March 2003

Although the advancement of molecular oncology in gastric cancer lags behind that of colorectal cancer, the rapid developments witnessed in recent years have improved our understanding of the carcinogenesis, aetiology, progression and metastasis of gastric cancer. The different molecular genetic alterations in intestinal and diffuse types of gastric cancer have further supported the concept that these two pathological types are different disease entities. The association of telomerase and cadherin changes with Helicobacter pylori infection reinforces its aetiological role. The mutated cadherin gene identified in familial gastric cancer has shone light onto the pathogenesis. Adhesion molecules have already been applied to daily clinical practice as prognostic markers. Future molecular studies will contribute to the screening, classification, disease monitoring and therapeutics of gastric cancer.

© 1999 Blackwell Science Asia Pty Ltd
Mixed cryoglobulinaemia associated with hepatitis C virus infection: A predictor factor for treatment with interferon?
Authors: Pellicano Rinaldo , Marietti Giorgio , Leone Nicola , Arena Vincenzo , Palmas Franco , Rizzetto Mario , Ponzetto Antonio
Published: March 2003

Background and Aims
: Mixed cryoglobulinaemia (MC) is a frequent finding among patients infected with hepatitis C virus (HCV). The response to treatment with alpha‐interferon (α‐IFN) in these patients is linked to predictive factors. The aim of this study was to ascertain whether the presence of MC was a predictive factor of response in patients treated with α‐IFN for chronic hepatitis due to HCV.

Methods
: Thirty‐two patients with MC and HCV infection (24 with chronic hepatitis and eight with cirrhosis) were compared with 30 patients with HCV infection without MC (23 chronic hepatitis, seven cirrhosis) of a similar mean age. All were treated with lymphoblastoid α‐IFN, at 3 MU, t.i.w., for 6–12 months and then followed up.

Results
: No statistical difference was observed between the two groups in terms of sustained response (P = 0.83), relapse (P = 0.88) and non‐response (P = 0.92). The mean follow up was 24.3 months (range 17–28) for patients with sustained response and for the patients with MC and 22.6 months (range 15–26) for patients without MC.

Conclusions
: The presence of cryoglobulinaemia does not influence the response to α‐IFN in patients with chronic HCV infection.

© 1999 Blackwell Science Asia Pty Ltd
Coagulation abnormalities in idiopathic portal venous thrombosis
Authors: Ahuja Vineet , Marwaha Neelam , Chawla Yogesh , Dilawari Jung Bahadur
Published: March 2003

Background
: Portal vein thrombosis, usually idiopathic, is the cause of portal hypertension in 46% of Indian patients, who present with a variceal bleed. The presence of lupus anticoagulant (LA) and antithrombin III deficiency have been reported to be associated with an increased tendency to venous thrombosis.

Methods and Results
: We studied 30 patients with portal venous thrombosis diagnosed by ultrasound. Two patients were positive for a lupus anticoagulant and both had very prolonged partial thromboplastin time with kaolin. None of the patients had antithrombin III deficiency.

© 1999 Blackwell Science Asia Pty Ltd
ONE‐WEEK TRIPLE THERAPY FOR ERADICATION OF H. PYLORI (with ranitidine bismuth citrate, clarithromycin [250 or 500 mg] and amoxillin or tinidazole)
Authors: Takats Alajos , Gero G. , Szentmihalyi A. , Novak J. , Pesci GY. , Szamosi SZ.
Published: March 2003

Objective

It hasn’t enough data for the brand‐new short‐term triple therapy with ranitidin bismuth citrate (RBC) and two antibiotics. In present our aim is to evaluate the efficacy of brand‐new one‐week triple therapy (containing ranitidin bismuth citrate, Clarithromycin [CLA] and Amoxillin [AMOX] or tinidazole [TIN]) in 124 HP positive patients (PTS) (45 with active peptic ulcer and 79 with chronic antral gastritis/ulcer was in their case‐history/).

Material & Method

We tried to use the following drugs combinations for treatment for one week: Group RBCCA: 400 mg RBC bid, 500 mg CLA bid, 1000 mg AMOX bid, group RBCC 500 T : 400 mg RBC bid, 500 mg CLA bid, 500 mg TIN bid, group RBCC250T: 400 mg RBC bid, 250 mg CLA bid, 500 mg TIN bid, group RBCC500T: 400 mg RBC bid, 500 mg CLA bid, 500 mg TIN bid. In ulcer‐PTS 300 mg/day ranitidin treatment was applied for 3 weeks. Upper GI endoscopy was performed with histological, cultivation and/or rapid urease test (RUT) examination prior to and 6 weeks after eradication. We assessed healing rate of peptic ulcer, alteration in the activity of chronic gastritis, and tolerability of the treatment.

Result

118out of 124 PTS completed the trial (drop out: 6, male: 51, aver. age: 50.28 ys, smoker: 53). Sex PTS dropped out (3 of them in consequence of side effect / diarrhoea and abdominal pain/) Complete ulcer healing was confirmed in all (41) ulcer‐PTS. HP was eradicated in 104 out of 118 PTS (PP:88.1%, ITT: 83.9%). The detailed results are shown on following chart:

Group
TTP
Ulcer.g
Gastritis.
g. RBCCA

RBCCA
84.88 %
88.6 %
92.9 %
86.6 %

RBCC 250T
86.5 %
91.4 %
92.3 %
81.8 %

RBCC 500T
80.5 %
84.6 %
78.6 %
88 %

The drug regimen was very well tolerated (only in 11 cases [8.9 %] they were side effects: nausea, pyrosis, headache and diarrhoea).

Conclusion

All of the one‐week triple therapy (cont.RBC) was as effective to eradicate HP as the other triple therapies. The short duration and few side effects ensure the compliance of the PTS.
HISTOLOGICAL DEGREE IN HELICOBACTER PYLORI GASTRITIS IN RELATION TO THE ABSENCE OR PRESENCE OF BILE REFLUX
Authors: Rani Abdul Aziz
Published: March 2003

Background:

the presence of Helicobacter pylori (Hp) in gastric mucosa could be influenced by bile reflux.

Aims:

to compare the histological parameters of gastric mucosal biopsies in bile reflux positive and bile reflux negative among the Hp gastritis.

Methods:

One hundred and forty four patients (M=73, F=71) with Hp gastritis from the private hospital in Jakarta were enrolled in this study. Two biopsy specimens (antrum and corpus of gaster) were taken from all consecutive patients during the period of January 1998 to December 1999. The grade of gastritis was examined according to the Sydney System (chronic inflammation, neutrophillic infiltration, glandular atrophy and intestinal metaplasia). Presence of Hp infection was determined by histology. A single senior Pathologist did all histopathological assessment. Bile reflux was defined as an evidence of significant amount of bile in gastric lumen with or without hyperemia and/or erosion on gastric mucosa. The presence of raptor during the procedure was an exclusion criteria.

Result:

twelve (M=4, F=8) out of 144 were positive for bile reflux. Comparison of the average scores of the different histologic features of the biopsy specimens among those with bile reflux and without bile reflux showed that chronic inflammation, neutrophillic infiltration, glandular atrophy and intestinal metaplasia was statistically not significant.

Conclusion:

chronic gastritis induced by Hp, suggestively not related to the absence or presence of bile reflux
TIME TRENDS OF HELICOBACTER PYLORI RELATED DISEASES FOR THE PAST DECADE
Authors: Jovannovic Ivan , Bulajic Milutin , Milosavljevic Tomica , Bulajic Mirko
Published: March 2003

Objective

Most countries have registered decline in distal (antrum and corpus) gastric cancer incidence and mortality. On the other hand, adenocarcinoma of the gastric cardia has been increasing with the unknown risk factor being responsible. We studied the time trends of Helicobacter pylori related diseases in the past decade.

Material and methods

This study was based on endoscopy reports of 37 369 in‐ and out patients collected from The Department of The diagnostic endoscopy; Clinic of Gastroenterology and hepatology ‐ Belgrade between 1987 and 1997. Diagnosis of the underlying disorder was established according to the currently accepted endoscopical and histopathological criterion.

Result

From 1987 and 1997, hospitalization rates for gastric ulcer as well as distal gastric cancer fell (P<0.05), while the hospitalization rate for gastro‐esophageal reflux disease and duodenal ulcer did not change (P<0.05). At the same time, hospitalization rate for gastric cardia cancer rose. When this is compared to the time trends of the duodenal ulcer significant difference between those two trends was observed (P<0.01).

Conclusion

Opposing time trends of duodenal ulcer versus gastric cardia center is consistent with hypothesis that the declining infection rates for Helicobacter pylori due to the active therapy, in the general population may actually have led to a rise in the occurrence of proximal gastric cancer.
Determination of the optimal cut‐off value for the [13C]‐urea breath test based on a Helicobacter pylori‐specific polymerase chain reaction assay
Authors: Yoshida Haruhiko , Hirota Katsutaro , Ogura Keiji , Maeda Shin , Shiratori Yasushi , Sasaki Yasuhito
Published: March 2003

Background
: This study was conducted to determine the optimal cut‐off value and breath sample collection time for the [13C]‐urea breath test based on the assessment of Helicobacter pylori status with a gastric juice‐based polymerase chain reaction (PCR) assay.

Methods and Results
: A total of 104 patients took 100 mg [13C]‐urea orally and breath samples were collected at 5, 10, 20, 30 and 60 min. The increment of 13CO2:
12CO2 ratio from the baseline (δ13C) was measured using a laser spectroanalyser. The PCR assay was positive in 63 and negative in 41 patients. The optimal cut‐off value of δ13C was calculated for each sample collection time so that the distance from the geometric mean value among Helicobacter pylori‐positive patients and that from the arithmetic mean value among negative patients were simultaneously maximized. The cut‐off value of 2.7‰ at 20 min had the longest distance, being separated by 3.16 SD from the two mean values. Using this cut‐off value, the urea breath test showed 100% specificity and 98% sensitivity for the diagnosis of Helicobacter pylori infection.
Liposome‐encapsulated OK‐432 specifically and sustainedly induces hepatic natural killer cells and intermediate T cell receptor cells
Authors: Yamagiwa Satoshi , Ichida Takafumi , Sato Kazunari , Sugahara Satoshi , Yonekura Kenji , Uchida Moriaki , Uehara Kazuhiro , Katoh Masashi , Satoh Hiroshi , Abo Toru , Asakura Hitoshi
Published: March 2003

Background
: OK‐432 is a biological response modifier used in Japan to augment host immunity and is known to increase the host antitumour response. By using liposomes, which are vesicles made from phospholipids that have a structure resembling the cell membrane, we encapsulated OK‐432.

Methods and Results
: Encapsulated OK‐432 was injected into the tail veins of mice, and its effect was compared with that of unencapsulated OK‐432 given intravenously. In mice that received either form of OK‐432, both the number of natural killer (NK) and intermediate T cell receptor (intTCR) cells (intrahepatic T cells generated by extrathymic differentiation) increased markedly in the liver, with the peak level occurring 3 days after administration. Both forms of OK‐432 also increased cytotoxic activity against Yac‐1 cells. The increase in numbers of cells and in cytotoxic activity in the liver persisted for longer in mice that received encapsulated OK‐432 than in animals that received unencapsulated OK‐432.

Conclusions
: Because it has been shown that both NK and intTCR cells play an important role in tumour immunity, an increase in the number of such cells can be considered likely to have an increased antitumour effect. Encapsulated OK‐432 elicited liver‐specific augmentation of cytotoxic activity and the effect was more persistent than that produced by OK‐432 given in the conventional form; therefore, it may be useful for the treatment of tumours, particularly those arising in the liver.