bluuebunny/crossref_metadata_2025 huggingface dataset:
Monochloramine impairs mucosal blood flow response and healing of gastric lesions in rats: Relation to capsaicin‐sensitive sensory neurons
Authors: Takeuchi Koji , Suzuki Keizo , Mizoguchi Hiroyuki , Araki Hideo , Nishiwaki Hidekazu
Published: March 2003

Aims: We examined the effects of monochloramine (NH2Cl) on the gastric mucosal blood flow (GMBF) response and the healing of ethanol‐induced gastric lesions in rats.

Methods: Rats fasted for 18 h were given the 99% ethanol p.o. for induction of gastric lesions, and were fed normally from 1 h later onwards. Monochloramine, at non‐ulcerogenic doses (5~20 mmol/L), was given p.o. twice daily for 7 days, starting 2 h after ethanol treatment.

Results: Gastric lesions caused by ethanol healed almost completely within 7 days with re‐epithelialization. The repeated administration of NH2Cl significantly delayed the healing of ethanol‐induced gastric lesions in a dose‐dependent manner. The damaged mucosa showed a marked rise in H+ permeability, resulting in luminal acid loss, but this process was accompanied by an increase of mucosal blood flow. Monochloramine did not affect the increased mucosal H+ permeability observed in the stomach after damage by ethanol, but significantly inhibited the mucosal hyperemic response associated with luminal acid loss. Prior exposure of the mucosa to NH2Cl (20 mmol/L) did not affect the gastric hyperemic response caused by mucosal application of misoprostol (a prostaglandin E1 derivative) or NOR‐3 (a nitric oxide donor), but totally attenuated the increase of GMBF in response to intragastric capsaicin. Impaired healing and GMBF responses were also observed in rats following chemical ablation of capsaicin‐sensitive sensory neurons.

Conclusions: These results suggest that NH2Cl impaired the healing of acute gastric mucosal lesions at low concentrations, and this action may be attributable, at least partly, to the impairment of gastric hyperemic response caused by the dysfunction of capsaicin‐sensitive sensory neurons.
A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis
Authors: Shimoyama Shouji , Kuramoto Shu , Kawahara Masaki , Yamasaki Kazuki , Endo Hisako , Murakami Toshikazu , Kaminishi Michio
Published: March 2003

Abstract Pseudomyxoma peritonei (PMP) is a rare clinical entity in which a diffuse collection of intraperitoneal gelatinous fluid is associated with gelatinous implants on the peritoneal surfaces and omentum. Hematogenic or lymphatic metastasis is extremely rare. In addition, an inguinal mass as an initial presentation is also relatively rare. This is a case report of a PMP patient who had splenic metastasis and showed an inguinal tumor as an initial presentation. A 59‐year‐old female patient, who had undergone bilateral oophorectomy because of a ruptured ovarian mucinous tumor of boderline malignancy 12 years previously, presented a presumptive diagnosis of a left inguinal irreducible hernia. Computed tomography revealed a low density mass in the pelvic cavity and in the inguinal lesion, as well as in the spleen without any diseases around the organ. The preoperative serum carcinoembryonic antigen (CEA) level was elevated. The patient underwent a resection of gelatinous tumor in the pelvic cavity, splenectomy, and appendectomy, as well as left inguinal herniorrhaphy. Histological examinations revealed a splenic metastasis of PMP originating from the ovarian low‐grade mucinous tumor. She received postoperative intraperitoneal lavage as well as chemotherapy, and has survived for over 7 years postoperatively without any evidence of recurrence, as confirmed by repeated follow‐up CT examinations and CEA determination. Splenic metastasis of PMP is extremely rare; this represents only the third reported case of its kind in the literature. Furthermore, it should be noted that an inguinal tumor can sometimes be an initial presentation of PMP.
Economic evaluation of the societal costs of hepatitis B in South Korea
Authors: Yang Bong Min , Paik Seung Woon , Hahn Oh Serk , Yi Deok Hee , Choi Moon Suk , Payne Sarah
Published: March 2003

Background and Aims: Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health‐care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997).

Methods: The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates.

Results: The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV‐related diseases. The total cost (direct plus indirect) associated with HBV‐related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis‐related costs. In terms of disease‐related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health‐care expenditure for 1997.

Conclusions: This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.
Anti‐inflammatory response in patients with obstructive jaundice caused by biliary malignancy
Authors: Kimura Fumio , Miyazaki Masaru , Suwa Toshikazu , Sugiura Toshiyuki , Shinoda Tokuzou , Itoh Hiroshi , Nagakawa Koji , Ambiru Satoshi , Shimizu Hiroaki , Yoshitome Hiroyuki
Published: March 2003

Background: Obstructive jaundice potentially modulates the host defense mechanism resulting in perioperative infection. It has been reported that a systemic inflammatory response occurs in patients with obstructive jaundice. An anti‐inflammatory response was studied in 29 jaundiced patients undergoing biliary drainage.

Results: Plasma concentrations of interleukin (IL)‐10, soluble tumor necrosis factor receptor (STNFR) p55, STNFR p75, IL‐1 receptor antagonist (IL‐1ra), IL‐6 and soluble CD14 (sCD14) were measured by using immunoassay. Plasma concentrations of IL‐10, STNFR p55, STNFR p75, IL‐1ra, IL‐6 and sCD14 were significantly higher in jaundiced patients than in the controls (P < 0.01). After biliary drainage, the concentrations of IL‐10, the three cytokine antagonists, and IL‐6 decreased significantly (P < 0.05). The sCD14 concentration did not decrease. At the time of drainage, the concentrations of STNFR p55 and STNFR p75 were significantly higher in 10 patients with positive bile cultures than in 19 patients with negative bile cultures (P < 0.05). Bile cultures became positive 14 days after drainage in 10 patients, and remained negative in nine. The concentration of STNFR p55 before drainage was significantly higher in the former group (P = 0.05). The plasma concentrations of IL‐10 and STNFRs were significantly correlated with the IL‐6 concentration, body temperature and the white blood cell count (P < 0.05). Serum total bilirubin levels did not affect plasma levels of anti‐inflammatory mediators, and sCD14.

Conclusion: Jaundiced patients exhibited an anti‐inflammatory immune response that potentially modulates the host defense mechanism and results in anergy and increased susceptibility to infection. Biliary infection may be one of the major stimuli of the immune response.
Influence of climatic factors in the incidence of upper gastrointestinal bleeding
Authors: Nomura Tetsuya , Ohkusa Toshifumi , Araki Akihiro , Chuganji Yoshimichi , Momoi Masaru , Takashimizu Ichizen , Watanabe Mamoru
Published: March 2003

Background and Aim:

Previous reports have indicated seasonal fluctuations in the incidence of peptic ulcer activity, but the reasons for the seasonal pattern are not clear. We assessed the seasonal incidence of hematemesis caused by peptic ulcers or gastroesophageal varices, and the correlations between those and climatic factors.

Methods:

We examined the number of cases of upper gastrointestinal (GI) bleeding caused by gastric ulcer (GU), duodenal ulcer (DU), or gastroesophageal varices (varix) diagnosed by urgent endoscopies between 1 January 1996 and 31 December 1999 in our hospital (Tokyo Metropolitan Bokutou Hospital). We evaluated the monthly and seasonal incidence of them and investigated correlations among the incidence and climatic factors.

Results:

Four hundred and forty‐one patients participated in this study, including 275 patients with GU (62.4%), 51 (11.6%) with DU, and 115 (26.0%) with varix. The number of cases of hematemesis caused by GU showed significant monthly and seasonal fluctuations (P = 0.0002, P = 0.0018): it decreased in summer and increased in autumn–winter. Moreover, there were inverse relations between the monthly number of cases of hematemesis caused by GU and the mean temperature (P = 0.0016) and vapor pressure (P = 0.0013), and a parallel relation to the mean atmospheric pressure (P = 0.0057). In contrast, the number of cases of hematemesis caused by DU and varices did not show any monthly or seasonal fluctuations.

Conclusions:

We found that the incidence of hematemesis because of GU had an inverse relationship to temperature and vapor pressure, and had a parallel relation to atmospheric pressure. Therefore, climatic factors may play an important role in hemorrhage from GU.
Influence of gender difference and gastritis on gastric ulcer formation in rats
Authors: Liu Edgar SL , Wong Benjamin CY , Cho Chi‐Hin
Published: March 2003

Background: Male patients with gastritis are found to have a high risk of developing peptic ulcer diseases. However, how gastritis or gender difference affects gastric ulcer formation is unclear. The present study aimed to investigate the relationship between ethanol‐induced acute gastritis and gastric ulcer formation in rats.

Methods: Acute gastritis or gastric ulcer was induced in the rat stomach by 80% ethanol or 60% acetic acid, respectively. Rats were killed either with gastritis alone or thereafter at day 1, 3 or 6 after ulcer induction. The number of proliferating and apoptotic cells, the mucosal mucus and prostaglandin E2 (PGE2) level were also determined.

Results: Male rats with acute gastritis potentiated gastric ulcer formation, while gastritis in female rats prevented ulceration. Female rats with gastritis had a significantly faster ulcer‐healing rate. More apoptotic cells were found in the gastritis groups, but only the female gastritis group produced more proliferating cells and had a decrease in the apoptosis‐over‐proliferation ratio. The mucus level was higher in female rats after ulcer induction. Mucosal PGE2 level was higher in female rats with acute gastritis. Both mucus and PGE2 were increased during ulcer healing in both genders.

Conclusions: This study shows that gender difference plays a role in the pathogenesis of ulcer formation. The number of cells with apoptosis or proliferation determines, in part, the gender difference on gastric ulcer formation in rats. Gastric PGE2 not only contributes to this process, but also together with gastric mucus participates in the ulcer‐healing process in the stomach.
Intraductal ultrasonography for hepatocellular carcinoma with tumor thrombi in the bile duct: Comparison with polypoid cholangiocarcinoma
Authors: Tamada Kiichi , Isoda Norio , Wada Shinichi , Tomiyama Takeshi , Ohashi Akira , Satoh Yukihiro , Ido Kenichi , Sugano Kentaro
Published: March 2003

Background and Aim: Tumor thrombi in the bile duct caused by hepatocellular carcinoma (HCC), and cholangiocarcinoma show polypoid lesions on cholangiographic findings. This study prospectively compared the images of intraductal ultrasonography between HCC and polypoid cholangiocarcinoma.

Methods: In five patients with tumor thrombi in the bile duct caused by HCC, a 2.0 mm diameter ultrasonic probe with a frequency of 20 MHz was inserted into the bile duct via the transpapillary route (n = 4) or the transhepatic route (n = 1). The images were compared to that of 65 patients with cholangiocarcinoma.

Results: In all patients with HCC, intraductal ultrasonography showed a ‘polypoid tumor with a narrow base’. In 16 of 65 patients with cholangiocarcinoma, it showed a ‘polypoid tumor with a narrow base’. When intraductal ultrasonography showed a ‘polypoid tumor with a narrow base’, the findings of a positive ‘nodule within a nodule’ (40 vs 0%; P < 0.05), and the absence of a ‘papillary‐surface pattern’ (80 vs 13%; P < 0.05) were more highly associated with tumor thrombi caused by HCC than to polypoid‐type cholangiocarcinoma.

Conclusions: Intraductal ultrasonography was useful to distinguish between tumor thrombi caused by HCC and polypoid‐type cholangiocarcinoma.
Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn's disease, ulcerative colitis, and other forms of colitis
Authors: Tanaka Masanori , Masuda Takayuki , Yao Takashi , Saito Hiroshi , Kusumi Tomomi , Nagura Hiroshi , Kudo Hajime
Published: March 2003

Abstract Background and Aim: Simple mucosal biopsy criteria proposed by authors reliably differentiate idiopathic inflammatory bowel disease (IBD) from other forms of colitis (non‐IBD) and Crohn's disease involving the colon (CD) from ulcerative colitis (UC). The aim of this study is to investigate the reproducibility of these criteria.

Methods: Three established pathologists and two medical students blindly examined 20 sets of multiple biopsy slides from patients with CD, 20 from those with UC, and 20 from those with non‐IBD. The students had been given instructions on histological definitions using another 15 sets previously. Each observer evaluated 10 histological items required in the criteria and determined categorical diagnoses such as definite IBD and probable UC. Interobserver agreement for the individual histological items was measured by using kappa analysis and Pearson's correlation, while it was measured for categorical diagnoses with the use of Spearman's rank correlation.

Results: All of the individual histological items expressed excellent or fair‐to‐good agreement among the five observers, although two items associated with the criteria for CD and UC had poor agreements among the students. With regard to categorical diagnoses based on the criteria for IBD and non‐IBD, and those for CDand UC, coefficients for Spearman's rank correlation exceeded 0.92 and 0.86 among the pathologists, and 0.76 and 0.74 among the students, respectively; all of the coefficients were statistically significant (P < 0.05).

Conclusions: The simple criteria were sufficiently reproducible and would help most pathologists to make an automated and objective diagnosis.
Profile, spectrum and significance of HBV genotypes in chronic liver disease patients in the Indian subcontinent
Authors: THAKUR VARSHA , GUPTAN RAJKUMAR CHANDRA , KAZIM SYED NAQUI , MALHOTRA VEENA , SARIN SHIV KUMAR
Published: March 2003

Background and Aim Certain hepatitis B virus (HBV) genotypes have been alleged to be associated with the development of cirrhosis and hepatocellular carcinoma (HCC), and the response to interferon therapy in Taiwanese patients. We undertook to study the prevalence and significance of HBV genotypes in the Indian subcontinent.

Methods One hundred and thirty histopathologically proven chronic HBV‐infected patients, including 52 incidentally detected asymptomatic hepatitis B surface antigen (HBsAg)‐positive subjects (IDAHS) with chronic HBV infection (group I), 48 cirrhotics (group II) and 30 hepatocellular carcinoma (HCC; group III) patients were studied. Hepatitis B virus genotypes were determined by using restriction fragment length polymorphism, and direct sequencing of the s gene including the ‘a’ determinant region.

Results Only genotypes A (46%) and D (48%) were found in the chronic HBV‐infected patients. A mixed infection with genotypes A and D was seen in 6% of patients. Genotype A was found in 42, 48 and 50%, and genotype D in 48, 50 and 47% of group I, II and III patients, respectively (P = NS). The patients who had mixed genotypes were significantly younger (P < 0.05). In group I (IDAHS) patients infected with genotype D, none had a histological activity index (HAI) of < four. Genotype D was significantly more common in group I patients with HAI > 4 as compared to genotype A (53 vs 32%, P < 0.05). Similarly, genotype D was associated with more severe liver diseases (61 vs 30%, P < 0.05). Genotype D was more prevalent in HCC patients of < 40 years of age, as compared to IDAHS (63 vs 44%, P = 0.06).

Conclusions (i) Hepatitis B virus genotypes A and D are prevalent in chronic liver disease patients of Indian origin; and (ii) HBV genotype D is associated with more severe diseases and may predict the occurrence of HCC in young patients.
Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection
Authors: YAGI KAZUYOSHI , NAKAMURA ATSUO , SEKINE ATSUO
Published: March 2003

Background and Aims: The aim of this study was to clarify the endoscopic features of the Helicobacter

pylori (H. pylori)‐free stomach by examining the arrangement of minute points

visible on the corpus. Since these points were clarified by magnifying endoscopy

as collecting venules, this finding was termed ‘regular arrangement of collecting

venules (RAC)’. The findings from more endoscopic studies are presented and

the differences between magnified views of the normal and H. pylori‐infected corpus and antrum are described in particular.

Methods: The study group consisted of 557 patients who were subjected to endoscopy and checked for H. pylori. The RAC in each patient was assessed. Magnifying endoscopy in 301 patients was used to examine the corpus and in 94 patients to examine the antrum.

Results: One hundred and fifty‐eight patients had normal stomachs without H. pylori.

We diagnosed 389 patients with H. pylori gastritis. In 10 patients

H. pylori was not detected, but inflammation was present. Of the 158 patients

with H. pylori‐negative normal stomachs, 151 had RAC. As a determinant of

the normal stomach without H. pylori infection, the presence of RAC had 93.8%

sensitivity and 96.2% specificity. All 30 patients with H. pylori‐negative

normal stomachs had a well‐defined ridge pattern (wDRP) on the antrum as observed

under magnifying endoscopy. As a determinant of the normal stomach without H.

pylori infection, wDRP had a specificity of 100%, but a sensitivity of only 54.5%.

Conclusions: The presence of RAC is characteristic of a normal stomach without H. pylori. Magnified views of the normal antrum were different from that of the normal corpus.
Iron‐deficiency anemia complicating AL amyloidosis with recurrent small bowel pseudo‐obstruction and hindgut sparing
Authors: HURLSTONE DP
Published: March 2003

Abstract 
AL amyloidosis complicating multiple myeloma is rare but well recognized. Endoscopic appearances of amyloid in the gastrointestinal tract can, however, be highly variable. Macroscopic appearances of the duodenum can range from scalloping (often seen in celiac disease) to that of duodenitis; erosive disease, frank ulceration and even protruberant masses. The importance of small bowel biopsies at the time of duodenal intubation and in gastroscopic examinations for iron deficiency anemia, must therefore be stressed.

© 2002 Blackwell Publishing Asia Pty Ltd
Treatment of alcoholic hepatitis
Authors: Maher Jacquelyn J
Published: March 2003

Abstract  Alcoholic hepatitis is a common disease with an overall 1‐year mortality of 20%. Although the classical treatment for alcoholic hepatitis is abstinence, in some individuals abstinence alone is inadequate to promote survival and recovery. This is particularly true of patients with severe alcoholic hepatitis, who are identified by jaundice, coagulopathy and neutrophilia. Within the last two decades, several agents have been examined as treatments for alcoholic hepatitis and cirrhosis. They have targeted several key processes in the pathophysiology of alcoholic liver disease, including hypermetabolism, inflammation, cytokine dysregulation and oxidant stress. The compounds that offer the greatest survival benefit to patients with severe alcoholic hepatitis are corticosteroids. Several groups have reported excellent results with corticosteroids, but positive results are not uniform, and there remains some controversy over their efficacy. Even if corticosteroids are beneficial for alcoholic hepatitis, they are not recommended for all patients at risk. Consequently, other agents are being tested that have broader applicability to individuals with contraindications to steroids. In this regard, pentoxifylline shows some promise, as does enteral feeding with medium chain triglycerides. Independent efforts are also being directed toward treatment of chronic alcoholic liver disease and alcoholic cirrhosis. Anti‐oxidants have received the greatest attention; drugs such as S‐adenosyl‐methionine may be of benefit. This and others are under active study.

© 2002 Blackwell Publishing Asia Pty Ltd
Deficiency of KIT‐positive cells in the colon of patients with diabetes mellitus
Authors: NAKAHARA MASANORI , ISOZAKI KOJI , HIROTA SEIICHI , VANDERWINDEN JEAN‐MARIE , TAKAKURA RENA , KINOSHITA KAZUO , MIYAGAWA JUN‐ICHIRO , CHEN HUI , MIYAZAKI YOSHIJI , KIYOHARA TATSUYA , SHINOMURA YASUHISA , MATSUZAWA YUJI
Published: March 2003

Background

Diabetes mellitus is a well‐known cause of gastrointestinal dysmotility. The pathogenesis of diabetic gastroenteropathy is mainly considered to be a neuropathy, but the cause of dysmotility remains unknown. Interstitial cells of Cajal (ICC), which express c‐kit receptor tyrosine kinase (KIT), are considered to be pacemaker cells for the gastrointestinal movement. Therefore, we investigated a possible involvement of ICC in the pathogenesis of diabetic gastroenteropathy in humans.

Methods

The KIT‐positive cells in the proper muscle layer of the colon were detected by immunohistochemistry in patients with diabetes mellitus and normal control subjects. Mast cells, which are also known to express KIT, were detected by staining with Alcian blue. The numbers of KIT‐positive cells and Alcian blue‐positive cells in the proper muscle layer were counted under the microscope and the number of KIT‐positive cells apart from Alcian blue‐positive cells was calculated.

Results

In the normal control subjects, KIT‐positive cells were located at the myenteric plexus region and in the circular muscle layer of the colon. Their distribution pattern was similar to that of ICC. The average number of KIT‐positive cells, apart from mast cells (which reflects the number of ICC), in patients with diabetes mellitus was approximately 40% of that found in normal subjects.

Conclusions

Deficiency of ICC might be related to the pathogenesis of diabetic gastroenteropathy in humans.
Gallstone disease prevalence in Western Siberia: Cross‐sectional ultrasound study versus autopsy
Authors: RESHETNIKOV OLEG V , RYABIKOV ANDREI N , SHAKHMATOV SERGEI G , MALYUTINA SOFIA K
Published: March 2003

Background

The aims of this study were: (i) to evaluate the prevalence of gallstones in a Western Siberian urban population; and (ii) to compare the results of ultrasonographic screening of the living population with hospital autopsy data.

Methods

A representative sample of 842 men and 870 women (aged 25–64 years) living in Novosibirsk, Western Siberia, was screened for the presence of gallstones by gallbladder ultrasonography. Participants were considered to have gallstone disease if they had already had cholecystectomy or if gallstones were revealed during the survey. Hospital autopsy data (n = 1124) were reviewed retrospectively for the 8‐year period in the same region.

Results

The prevalence of gallstone disease was significantly higher in women than in men and increased with age. Age‐adjusted prevalence rates of gallstone disease for the 25–64‐year age group were 1.9% in men and 9.5% in women in a cross‐sectional ultrasonographic study. Corresponding values in the autopsy series were 2.2% in men and 11.2% in women.

Conclusions

The present report shows that the prevalence of gallstone disease in the female population is in the range of that reported from Western countries, whereas that in the male population is lower than that in other countries. The results of the ultrasonographic survey of the living population and of hospital autopsy data were comparable, with slightly higher gallstone detection rates in the autopsy study.
Hepatitis C advances in antiviral therapy: What is accepted treatment now?
Authors: Mchutchison John G
Published: March 2003

Abstract  The vast number of patients with hepatitis C represent a huge medical and economic burden. While 20–30% of these patients progress and develop advanced liver disease, the majority do not. Thus, it is crucial to identify patients suitable for treatment and those who may benefit most from therapy. Anti‐viral therapy is recommended for those patients with chronic hepatitis C who also have elevated liver tests, detectable hepatitis C virus ribonucleic acid and significant inflammation and/or fibrosis on liver biopsy. Currently, the most effective initial therapy is the combination of interferon plus ribavirin. The sustained viral response rate (SVR) is 36–41% following a 24‐ or 48‐week course of therapy. In general, patients with the genotype 1 infection should receive 48 weeks of therapy, and those with genotypes 2 or 3 infection only 24 weeks. Viral load estimations are problematic because of normal fluctuations (up to 0.5–10 log), assay variability and lack of a universally accepted standard; thus, viral load testing is not recommended routinely at present. The sustained viral response rate produces improvements in quality of life and liver histology (including reversal of bridging fibrosis and cirrhosis is some), and durable responses lasting 5–11 years in 95–97% of cases. While the optimal dose of ribavirin is currently unknown, available data suggest that higher doses increase efficacy (albeit with a greater degree of anemia). The dose of 800 mg/day may be the most appropriate lower dose for those patients who require dosage modification for anemia or other side‐effects. Patients who have relapsed after interferon monotherapy can be successfully retreated with higher doses of interferon for 1 year or the combination of interferon and ribavarin for 24–48 weeks. Preliminary data suggest that patients with an unfavorable profile, including those with genotype 1 infection, should probably be retreated with interferon and ribavirin for 48 rather than 24 weeks.

With our current best therapies, the majority of patients still do not achieve the benefits of a sustained response. Re‐treatment with interferon and ribavirin may achieve a sustained response in approximately 10–25% of these patients. In the immediate future, once‐weekly pegylated interferons will replace standard interferons. Initial data suggest that SVR achieved with these drugs in combination with ribavirin is increased to 54–61%, but dose modifications and side‐effects are more frequent. They will thus provide an incremental benefit in terms of efficacy, particularly for genotype 1‐infected patients.

© 2002 Blackwell Publishing Asia Pty Ltd
Granulomatous phlebitis of small hepatic vein
Authors: SAITO TAKAHITO , HARADA KENICHI , NAKANUMA YASUNI
Published: March 2003

Abstract
 
Several cases of granulomatous phlebitis of small hepatic veins are reported in the literature, though the etiology remains unclear. We experienced a similar case of granulomatous phlebitis involving terminal hepatic venules and this case will be reported in comparison with two previous cases presenting in our laboratory. A 39‐year‐old‐female had a long course of medical treatment for epilepsy. She suffered from acute liver injury after prolonged fever for more than 1 week. Leukocytosis (11 100/µL) without eosinophilia, and inflammatory reactions such as C‐reactive protein (21.0 mg/dL) were pointed out. She suffered from transient disseminated intravascular coagulation, but these abnormalities recovered with antibiotic and steroid therapy. Liver biopsy revealed granulomatous lesions mainly involving terminal hepatic venules. The possibility of tuberculosis was excluded by a negative Thiel–Nielsen stain and a negative molecular study for bacterial deoxyribonucleic acid of Mycobacteria species. Extrahepatic involvements were not clear clinically. This case and the previous two cases shared granulomatous phlebitis of the intrahepatic small hepatic veins, as well as clinical features suggestive of bacterial infection. Clinicians should be aware of such a rare clinicopathological entity.

© 2002 Blackwell Publishing Asia Pty Ltd
Influence of diet complexity on intestinal adaptation following massive small bowel resection in a preclinical model
Authors: Bines Julie E , Taylor Russell G , Justice Frances , Paris Monique C J , Sourial Magdy , Nagy Eva , Emselle Sarah , Catto‐Smith Anthony G , Fuller Peter J
Published: March 2003

Aims:
To investigate the effect of dietary complexity on intestinal adaptation using a preclinical model.

Methods:
Four‐week‐old piglets underwent a 75% proximal small bowel resection or transection operation (control). Post‐operatively, animals received either pig chow (n = 15), polymeric formula (n = 9), polymeric formula plus fiber (n = 6), or elemental formula (n = 7).

Results:
The weight gain of all groups was reduced compared with controls that were fed the same diet. Animals that had a resection, which were fed elemental formula, had significantly reduced weight gain compared with the other groups (4.7  4.2 vs 30.7  7.1 kg chow and 11.5  1.3 kg polymeric formula). Villus height was increased in the jejunum, ileum and terminal ileum of resected animals compared with controls in animals fed with pig chow, polymeric formula and elemental formula. The animals that had a resection had a significant reduction in the transepithelial conductance (10.4  5.5 vs 25.4  6.5 mS/cm2) and 51Chromium‐EDTA flux (2.8  1.9 vs 4.8  4.9 µL/h per cm2) compared with the controls.

Conclusions:
A complex diet was found to be superior to an elemental diet in terms of the morphological and functional features of adaptation following massive small bowel resection.

© 2002 Blackwell Publishing Asia Pty Ltd
Delayed gastrointestinal transit in patients with hepatocellular carcinoma
Authors: CHEN CHIH‐YEN , LU CHING‐LIANG , CHANG FULL‐YOUNG , LIH‐JIUN KANG , LUO JIING‐CHYUAN , LU REI‐HWA , LEE SHOU‐DONG
Published: March 2003

Background and Aim:
Disturbed gastrointestinal (GI) motility exists in cirrhotic patients; however, less is known about the character of GI transit in hepatocellular carcinoma (HCC) patients. It is interesting to study the GI transit in HCC patients and to explore the patient factors modulating GI transit.

Methods:
A non‐invasive hydrogen breath test, which measured the orocecal transit time (OCTT), was used to study GI transit in 40 HCC patients, 20 cirrhotics and 40 age‐ and sex‐matched healthy volunteers with normal bowel habits. Meanwhile, their clinical manifestations and various blood parameters, such as platelet count, prothrombin time, erythrocyte sedimentation rate etc. were collected. The plasma endothelin‐1 and nitrate/nitrite levels were also measured.

Results:
The OCTT were delayed in HCC and cirrhotic patients compared with controls (116.3 ± 7.8 and 104.5 ± 10.6 vs 75.3 ± 5.1 min, P < 0.05). Neither the severity of liver damage, presence of ascites, tumor size, portal hypertension, nor various blood parameters, such as nitrate/nitrite, endothelin‐1, platelet count etc., had any influence on GI transit. Only serum α‐fetoprotein levels exhibited a trend toward positive correlation with the OCTT (r = 0.271, P = 0.091).

Conclusions:
Hepatocellular carcinoma patients have delayed GI transit. The confounding factor responsible for the disturbance of GI transit in HCC patients needs further exploration.

© 2002 Blackwell Publishing Asia Pty Ltd
Effects of oxymatrine on the serum levels of T helper cell 1 and 2 cytokines and the expression of the S gene in hepatitis B virus S gene transgenic mice: A study on the anti‐hepatitis B virus mechanism of oxymatrine
Authors: DONG YUHONG , Xi HONGLI , YU YANYAN , Wang QINHUAN , JIANG KAN , LI LIUZHE
Published: March 2003

Background:
Oxymatrine has been shown to have a remarkable inhibitory activity to hepatitis B virus (HBV) infection with a hepatitis B virus e antigen (HBeAg) serum conversion rate of approximately 45%. In order to explore the anti‐HBV mechanism of oxymatrine, the effects of oxymatrine on serum levels of T helper (h)1 cytokines (interferon (IFN)‐γ and interleukin (IL)‐2) and Th2 cytokines (IL‐4 and IL‐10), and the expression of S gene in HBV S gene transgenic mice were studied.

Methods:
Each transgenic mouse was either injected with oxymatrine or saline intraperitoneally once a day for 30 days. Serum levels of IFN‐γ, IL‐2, IL‐4 and IL‐10 were quantitated and compared to the data before the treatment. The expression of HBV S gene in transgenic mice was analyzed at the DNA, mRNA and protein levels.

Results:
The serum levels of IFN‐γ in transgenic mice before or after oxymatrine treatment were 3.108 ± 3.172 and 11.059 ± 6.971 pg/mL, respectively. In contrast, serum levels before and after oxymatrine treatment for IL‐4 were 29.045 ± 13.235 and 13.024 ± 9.002 pg/mL, respectively (P < 0.001). The serum levels of IL‐2 in the control (saline injection) and oxymatrine‐treated mice were 1.070 ± 0.447 and 5.537 ± 2.887 pg/mL, respectively (P < 0.0001); and that of IL‐10 were 97.226 ± 73.306 and 33.607 ± 23.154 pg/mL, respectively (P < 0.01). No significant differences were observed in the expression of HBV S gene in the transgenic mice at the DNA, mRNA and protein levels before or after oxymatrine treatment.

Conclusions:
The fact that Th1 cytokines are increased while Th2 cytokines are decreased suggests that oxymatrine treatment triggers the change of immune response to hepatitis B infection in transgenic mice, which leads to improved HBV inhibitory activities. The study can help us better understand the mechanisms of the anti‐HBV drug, oxymatrine, and how it has potential as an application in clinical chronic hepatitis B treatment.

© 2002 Blackwell Publishing Asia Pty Ltd
Relationship between non‐steroidal anti‐inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: A case‐control study
Authors: OKAN ABDULLAH , TANKURT ETHEM , ASLAN BELGIN U , AKPINAR HALE , SIMSEK ILKAY , GONEN OMUR
Published: March 2003

Background and Aims: Non‐steroidal anti‐inflammatory drug (NSAID) use has been closely associated with an increased risk of bleeding peptic ulcers, while the prevalence of Helicobacter pylori infection has been reported to be lower in bleeding ulcers than in non‐bleeding ones. However, whether an interaction exists between NSAID use and H. pylori infection has not clearly been elucidated yet. The aims of this study were to determine the frequency of NSAID use and H. pylori infection, to predict risk factors in bleeding peptic ulcers and to determine whether NSAID use and H. pylori infection interact with each other.

Methods: Ninety‐six patients with bleeding ulcer were included in the study. The control group consisted of 106 patients with non‐bleeding ulcer. Data were analyzed by using the chi‐squared test, Fisher's exact test and logistic regression analysis with or without interaction term (H. pylori by NSAID).

Results: Non‐steroidal anti‐inflammatory drug use was significantly more common in patients with bleeding ulcers than in controls (79.2 vs 38.7%, unadjusted odds ratio (OR): 6.02, 95% confidence interval (CI): 3.21–11.29). The frequency of the H. pylori infection was significantly lower in patients with bleeding ulcers than in controls (66.7 vs 89.6%, unadjusted OR: 0.23, 95% CI: 0.10–0.49). In the logistic regression analysis with the interaction term, male sex (adjusted OR: 3.70, 95% CI: 1.65–8.29), multiplicity of ulcers (adjusted OR: 4.10, 95% CI: 1.02–16.45) and NSAID use (adjusted OR: 33.87, 95% CI: 4.36–262.97) were independent risk factors for bleeding ulcers. There was a negative interaction between H. pylori and NSAID use (adjusted OR: 0.09, 95% CI: 0.01–0.83).

Conclusions: The negative interaction between the two variables suggests that the presence of H. pylori is associated with a lower risk of bleeding in ulcer patients taking NSAIDs.

© 2003 Blackwell Publishing Asia Pty Ltd
Is smoking an indirect risk factor for the development of ulcerative colitis? An age‐ and sex‐matched case–control study
Authors: ABRAHAM NED , SELBY WARWICK , LAZARUS ROSS , SOLOMON MICHAEL
Published: March 2003

Background:  It has been suggested that smoking protects against the development of ulcerative colitis (UC). Evidence is mainly driven from the way data from a multitude of case–control studies have been interpreted.

Methods:  An age‐ and sex‐matched case–control study was conducted to further assess the association between history of smoking, past surgery, childhood, and other potential causative factors with the development of UC using the answers to a detailed questionnaire. The data were analyzed using univariate analysis and logistic regression. The results are presented as odds ratios (OR) and 95% confidence intervals.

Results:  One hundred and two cases and an equal number of matched controls were included in the study. Using a three‐level comparison, at the age of diagnosis, the risks of developing UC were 0.41 (0.19–0.87), 3.45 (1.62–7.35) and 0.78 (0.44–1.37) for smokers, ex‐smokers and non‐smokers, respectively. When compared to individuals who have never smoked, ex‐smokers were at a higher risk of developing the disease (OR = 3.00 (1.38–6.51)). The specific history of quitting smoking prior to the age of onset of symptoms was associated with an increased risk for developing the disease (OR = 3.45 (1.62–7.35)).

Conclusions:  Active smoking was associated with a low risk for the development of UC, but the lack of history of smoking was not associated with an increase in the risk. History of quitting smoking prior to the onset of symptoms, in contrast, was associated with a significant increase in the risk of developing the disease. These findings make the theory of a simple protective effect of smoking on the development of UC difficult to justify. It may be plausible to suggest that the withdrawal of the immunosuppressive effect of smoking triggers the disease onset in a genetically susceptible individual or simply unmasks its symptoms.
Non‐alcoholic steatohepatitis: What is it, and why is it important in the Asia–Pacific region?
Authors: FARRELL GEOFFREY C
Published: March 2003

Abstract  Non‐alcoholic steatohepatitis (NASH), is a critical link in the chain of metabolic fatty liver disorders that spans steatosis to cryptogenic cirrhosis. It is the hepatic manifestation of the insulin resistance (or metabolic) syndrome, and provides a clue to understanding fibrotic progression of other chronic liver diseases, particularly hepatitis C. Non‐alcoholic steatohepatitis is often the first clinical indication of insulin resistance, with its complications of high blood pressure, coronary heart disease and type 2 diabetes. Among those with risk factors, NASH is common: present in at least 20% of obese adults or children with or without type 2 diabetes, and at least 5% of those overweight. With emerging urbanization, increasing affluence and behavioral changes of physical inactivity and high fat/energy‐excessive diet, type 2 diabetes has become common in Asia and the western Pacific rim. The rates range from 7–40%, which in countries like Japan represents a 3–20‐fold increase (depending on age) over the last 20 years. The increase is associated with central adiposity, insulin resistance, hepatic steatosis and NASH. After cancer, cirrhosis from NASH is now the second most common age‐related cause of death in type 2 diabetes. Reversing these trends must become a public health priority; the first awakenings were evident in Taiwan at the time of this meeting. In order to stimulate clinicians to think more about the importance of metabolic liver disease for development of cirrhosis, this review will cover clinical and laboratory features, natural history and an approach to diagnosis and management of NASH. Some emerging concepts on pathogenesis will be mentioned briefly, but the emphasis will be on the potency of lifestyle adjustments (physical activity and diet) to prevent or reverse fatty liver disorders.
The long QT syndrome and seizures in childhood
Authors: DAVIS AM , WILKINSON JL
Published: March 2003

Children with the long QT syndrome (LQTS) are prone to life threatening ventricular arrhythmias. These arrhythmias may result in syncope and seizures that are often attributed incorrectly to a seizure disorder or to common fainting. The untreated mortality for symptomatic children with the LQTS is high but is improved significantly with therapy. Paediatricians should be aware of the presentations of the syndrome. Recommendations for screening for the syndrome are given.
An investigation into sleep characteristics of children with autism and Asperger’s Disorder
Authors: PATZOLD LM , RICHDALE AL , TONGE BJ
Published: March 2003

Objective:

The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour.

Methodology:

The Pervasive Developmental Disorder (PDD) group consisted of 31 children with autism and 7 children with Asperger’s Disorder ranging in age from 44 to 152 months. The control group consisted of 36 children ranging in age from 63 to 171 months. The children were matched on age and gender, and group‐matched on IQ level. A sleep diary was completed by parents over a 2‐week period, in addition to several behaviour questionnaires.

Results:

Results showed that children in the PDD group exhibited qualitatively and quantitatively different sleep patterns to nonautistic control children.

Conclusions:

The findings were discussed in light of current literature concerning circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.
Cyclic vomiting syndrome in South‐East Asian children
Authors: LEE WS , KAUR P , BOEY CCM , CHAN KC
Published: March 2003

Objective:

To describe the clinical features, management and outcome of children with cyclic vomiting syndrome (CVS) from South‐East Asia.

Methodology:

Retrospective review of all children who fulfilled the diagnostic criteria of CVS and who were seen at Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur and Paediatric Unit, Penang Hospital, Penang, Malaysia from 1987 to 1997.

Results:

Eight children with CVS were seen at the two units during the study period, five girls and three boys. All had cyclical, self‐limited episodes of nausea and vomiting with symptom‐free intervals. The mean age of onset was 5.9 years. The clinical features were similar to other series described in the literature. Only two of the eight children were described as ‘perfectionist’. Two children identified stress as precipitating factors. Therapy to reduce the number of emeses during acute attacks and to prevent subsequent attacks had been ineffective.

Conclusion:

There are similarities and differences in CVS from South‐East Asian children as compared to those described in the literature.
Seroprevalence of Helicobacter pylori infection in Malaysian children: Evidence for ethnic differences in childhood
Authors: Boey CCM , Goh K‐L , Lee WS , Parasakthi N
Published: March 2003

Objectives: To determine the prevalence of Helicobacter pylor (H. pylori) in healthy Malaysian children and to discover whether differences exist among children of different races.

Methods: Serum samples from asymptomatic children tested for H. pylori seropositivity using an ELISA test.

Results: Five hundred and fourteen healthy urban Malaysian children aged 0.5 to 17 (mean 5.9) years from three different racial groups had their blood tested for H. pylori antibodies. The overall prevalence was 10.3%. There was no significant difference in the prevalence of infection between boys and girls, but a significant rise was noted with increasing age (P = 0.009). Seropositivity was most common in the Indians and lowest in the Malays (P = 0.001). Father’s level of education did not affect the child’s rate of H. pylori seropositivity.

Conclusion: The prevalence of H. pylori seropositivity among asymptomatic urban Malaysian children is lowest in Malays, intermediate in Chinese and highest in Indians. The racial differences found in children are consistent with those found in Malaysian adults.
Stress experienced by mothers of Malaysian children with mental retardation
Authors: Ong LC , Chandran V , Peng R
Published: March 2003

Objective: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.

Methodology: Seventy‐five mothers of children with mental retardation aged 4–12 years and 75 controls (those without disabilities who attended the walk‐in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.

Results: Mothers of children with mental retardation scored significantly higher than control subjects in both the child‐related domain (difference between means 26.1, 95% confidence interval 19.6–32.5) and parent‐related domain (difference between means 15.0, 95% confidence interval 7.9–22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0.01) and sibship size (P < 0.01) were associated with child‐related domain scores. For the parent‐related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress.

Conclusion: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.
A clinical trial comparing oral azithromycin, cefixime and no antibiotics in the treatment of acute uncomplicated Salmonella enteritis in children
Authors: Chiu CH , Lin TY , Ou JT
Published: March 2003

Objective: The objective of this study was to perform a prospective, randomized, controlled study to evaluate the role of azithromycin and cefixime in the treatment of uncomplicated non‐typhoid Salmonella enteritis in children.

Methodology: Patients with Salmonella enteritis were randomized to receive oral azithromycin (10 mg/kg/day once daily), cefixime (10 mg/kg/day divided twice daily) or no antibiotics for 5 days. The patients were followed up for the duration of their symptoms. Stool samples were sent for culture weekly following the therapy until two consecutive negative results were obtained. Susceptibility of the isolates to antibiotics was tested by the disk diffusion method.

Results: Forty‐two patients with acute, uncomplicated, culture‐confirmed Salmonella enteritis were studied. Duration of diarrhoea and time to defervescence after the therapy were not significantly different for patients treated with azithromycin, cefixime, or no antibiotics; there also were no significant differences with respect to the rate of clearance of Salmonella from stools among the three groups. Salmonella typhimurium was the most common serotype isolated. All 42 isolates were sensitive to cefixime, while two strains (5%) were resistant to azithromycin.

Conclusions: Azithromycin or cefixime provides no benefit to paediatric patient with uncomplicated Salmonella enteritis.