bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of diet on the clinical course and repair of the small bowel mucosa in infantile gastroenteritis
Authors: IYNGKARAN N. , YADAV M. , BOEY C.G. , MENG L.L. , PUTHUCHEARY S.D. , LAM K.L.
Published: March 2008

The effect of cow milk protein (CMP), soy protein (SP) and protein hydrolysate formula (PHF), on clinical and mucosal recovery was studied in 26 infants with acute gastroenteritis associated with acquired carbohydrate intolerance.

Following rehydration the infants were regraded onto cows' milk. Of seven infants intolerant to the CMP six did not tolerate lactose‐free CMP and SP but thrived on PHF; the other infant was intolerant to lactose‐free CMP but accepted the SP. Of another 12 infants intolerant to CMP, eight tolerated SP and four did not but thrived on PHF. Seven other young infants who presented with severe clinical symptoms were placed directly on PHF. Biopsies were performed at initial illness, during the illness and following clinical recovery. The infants had a damaged mucosa while on an intolerant formula. The disaccharidase levels of the biopsy were low during the initial illness but increased rapidly during the recovery period. Rapid clinical and mucosal recovery was observed in nine infants who tolerated SP and 17 infants on PHF.

CMP challenge was conducted in 26 infants and 16 infants had cows' milk protein sensitive enteropathy (CMPSE) indicating that CMPSE was the basis for the persistent diarrhoea and impaired mucosal recovery in these 16 infants. The role of food protein sensitive enteropathy and other factors influencing the clinical course and mucosal recovery in young infants with acute gastroenteritis is discussed.
Defective suppressor function of spleen cells by neonatal thymectomy and persistence of experimental auto‐immune hepatitis in mice
Authors: WATANABE Y. , MASUDA K. , IKEMOTO Y. , KIKKAWA M. , NAKANISHI T. , KAWAKAMI H. , KAJIYAMA G.
Published: March 2008

The effects of neonatal thymectomy on a model of auto‐immune hepatitis prepared by immunizing A/J mice with syngeneic crude liver proteins were studied. Hepatitis was more severe in neonatally thymectomized mice (Group B) than in non‐thymectomized controls (Group A). Changes in the hepatic lobules were reduced in both groups 3 months after the final immunization, but inflammation around the portal areas tended to persist in Group B; only this group showed frequent infiltration of mononuclear cells accompanied by destruction of the limiting plate in the portal area. The serum level of auto‐antibody to liver‐specific membrane lipoprotein complex (LSP) and delayed‐type hypersensitivity (DTH) to LSP were higher in Group B than in Group A. The auto‐antibody to LSP was positive in both groups 3 months after the final immunization. Although it was significantly reduced in Group A compared with the level 3 days after the final immunization, it remained high in Group B. Liver damage, production of the auto‐antibody to LSP and DTH to LSP were reduced by adoptive transfer of normal murine spleen cells, but the spleen cells of neonatally thymectomized mice showed no such effects. These results suggest that normal spleen cells possess the capability of suppressing auto‐immune hepatitis, and the defect of this capability due to T‐cell dysfunction by neonatal thymectomy contributes to the promotion and persistence of auto‐immune hepatitis.
Natural history of hepatitis B surface antigen‐positive cirrhosis in Taiwan: A clinicopathological study
Authors: TSAI SUN‐LUNG , YANG PEI‐MING , LAI MING‐YANG , CHEN DING‐SHINN , HSU HEY‐CHI , WANG TEH‐HONG , SUNG JUEI‐LOW
Published: March 2008

To clarify the natural history of hepatitis B virus (HBV)‐associated liver cirrhosis, the clinical, laboratory and histological features of 174 untreated hepatitis B surface antigen (HBsAg)‐positive cirrhotics were analysed, with a mean follow‐up period of 34 months (range 8–135 months) after liver biopsy. Male patients were predominant (86.8%) and the mean age of the whole group was 45 years, s.d. = 12 (range 15–82 years). Serum HBeAg and HBV‐DNA positivity were 38.9% and 31.8%, respectively. The calculated annual rate of spontaneous HBeAg seroconversion was 6.4% which was significantly lower than that (12%) of patients with HBeAg‐positive chronic active hepatitis (CAH). Superinfection by δ‐agent was rare, and anti‐δ antibody was detected in only 1.7% of them. The occurrence rate of hepatocellular carcinoma in the whole group was 5.7%/year which was not higher than that of HBsAg‐negative cirrhotics (6.2%/year). Serial liver biopsy showed that in the late evolution of cirrhosis, hepatitic activity tended to decline. Active cirrhosis may represent the intermediate stage between CAH and inactive liver cirrhosis. The 5‐year survival probability rate of the patients belonging to Child's functional classes A, B and C was 83.4% (s.d. = 5.7), 79.2% (s.d. = 9.4) and 30.9% (s.d. = 14.3), respectively. Most patients were in a well‐compensated state on entry into the study and remained stable for several years after diagnosis. Major causes of death include massive variceal bleeding, hepatic failure and/or hepatorenal syndrome, infection and hepatocellular carcinoma.
Pharmacogenetic aspects of biological variability
Authors: KÜPFER A. , ZEUGIN T. , PREISIG R.
Published: March 2008

In the field of pharmacogenetics, new insights have been obtained over the past few years with respect to hepatic hydroxylation and acetylation of drugs. Metabolic defects within the particular enzyme systems can be accompanied by multiple consequences, such as altered pharmacokinetics and unexpected side‐effects of drugs.

In Caucasian populations, the genetic defect of hydroxylation of debrisoquine occurs in approximately 9% of the population. The mephenytoin‐type drug hydroxylation defect, resulting from another hydroxylation polymorphism, can be demonstrated in 5% and 18% of Caucasian and Asian population samples, respectively. Such interindividual (phenotypic) differences of oxidative drug elimination can be detected after the peroral administration of a single dose of debrisoquine and mephenytoin followed by an 8 h urine collection. In hydroxylation‐deficient subjects, dose‐dependent drug toxicities occur after chronic drug administration of β‐blockers, antidepressants, perhexiline, phenacetine and others.

With respect to the acetylation polymorphism, rapid and slow acetylator phenotypes exhibit approximately a 1: 1 distribution in Caucasian populations. That particular phenotype can be determined in plasma or urine after peroral administration of 500 mg sulfadimidine. A new test for the assessment of polymorphic acetylation has recently become available in the form of acetylamino‐formylamino‐methyluracil analysis in urine after peroral administration of caffeine. The clinical consequences of the inherited rapid and slow acetylation capacity of the liver are primarily relevant for slow acetylator phenotypes, because side‐effects of isoniazid, salazopyrine, hydralazine and procainamide occur more frequently in this condition.

Pharmacogenetics and ecogenetics are two closely related entities. It might therefore be speculated that pharmacogenetically determined predispositions will also influence the metabolism of as yet unknown endo‐ and xenobiotic substances. Their varying abundances, for
Portal hypertensive gastropathy
Authors: BAXTER J. N. , DOBBS B. R.
Published: March 2008

It has become increasingly recognized over the past decade that, apart from causing gastro‐oesophageal varices, portal hypertension has effects on the remainder of the gastrointestinal tract, in particular, the gastric mucosa. There have been numerous reports suggesting that ‘hypertensive’ gastric mucosa is a frequent cause of haemorrhage in patients with portal hypertension; the condition has been variously described as haemorrhagic gastritis, erosive gastritis, portal hypertensive gastritis, congestive gastropathy, gastric mucosal red spots, gastric mucosal vasculopathy or portal hypertensive gastropathy (PHG). The feature in common with all these descriptions is the observation of a gastric mucosal lesion which has a propensity to bleed.
Cystic fibrosis: A disorder of biological signal transduction
Authors: COOK D. I. , YOUNG J. A.
Published: March 2008

In this issue of the Journal an article by Wattchow et al. (from the laboratories of Prof. J. B. Furness in Adelaide) reports that vasoactive intestinal peptide (VIP)‐containing nerve terminals, normally present in the subepithelial regions of the nasal and intestinal mucosa, are absent in cystic fibrosis (CF) patients, although similar nerves supplying the enteric musculature are still present. Since nervous tissue is obviously not epithelial, these results draw attention to what is often overlooked, namely that, although CF manifests itself conspicuously as a disorder of epithelial transport function, it affects many non‐epithelial tissues as well. The appearance of Wattchow's elegant histochemical study provides us with a timely opportunity to review recent progress in the search for the underlying defect in CF. This brief review must necessarily be highly selective and the interested reader is referred to the reviews of Frizzell, Welsh and Fick and McPherson and Goodchild for additional reference.
Acute hepatitis due to etretinate
Authors: KAMM MICHAEL A. , DAVIES DAVID J. , BREEN KERRY J.
Published: March 2008

A case of acute hepatitis is reported in a 62 year old woman who had been treated for severe psoriasis with the aromatic retinoid, etretinate. Her clinical condition and liver function tests continued to deteriorate after cessation of the drug, but there was a marked initial response to therapy with prednisolone. Liver biopsy showed hepatitis with focal necrosis. There was clinical and biochemical evidence of relapse when prednisolone was withdrawn after 4 months, necessitating a further 11 months of prednisolone therapy.
Portographic changes with time in patients with extrahepatic portal venous obstruction
Authors: CHAWLA Y. K. , DILAWARI J. B.
Published: March 2008

Portographic changes of successive splenoportovenograms in 27 patients with extrahepatic portal venous obstruction (EHPO) over a mean period of 27 months have been studied. No extension of the portal vein thrombus was observed either in 20 patients with EHPO who had variceal obliteration by endoscopic sclerotherapy or in the 12 patients who remained without treatment for a mean period of 33.4 months (five of them were later subjected to sclerotherapy). There was no evidence of spread of thrombosis in the portal veins with time.
Hepatitis δ virus infection in India
Authors: ANAND A. C. , GANDHI B. M. , ACHARYA S. K. , IRSHAD M. , JOSHI Y. K. , TANDON B. N.
Published: March 2008

Serological markers of hepatitis δ virus (HDV) and hepatitis B virus (HBV) infection were studied in 87 HBsAg positive patients, comprised of 18 patients with uncomplicated acute viral hepatitis (AVH), 34 patients with fulminant hepatic failure (FHF), 18 patients with subacute hepatic failure (SAHF) and 17 patients with chronic active hepatitis (CAH). The prevalence of HDV infection was found to be 27.8%, 20.6%, 16.7% and 11.8%, respectively in these four groups. Co‐infection of HDV and HBV was common amongst patients with AVH but superinfection by HDV in chronic HBV carriers was the predominant form of infection in patients with FHF, SAHF and CAH. HDV superinfection in these groups did not significantly alter the common tests of liver function or the DNA‐polymerase positivity.
Short communication: Hepatitis B viral markers and liver disease in haemophiliacs: A study in an Indian population
Authors: RAMRAKHYANI K. C. , DILAWARI J. B. , VERMA S. , GHOSH K. , CHAWLA Y. K. , BHANDARI S. K. , GANGULY N. K.
Published: March 2008

Serological evidence of hepatitis B infection was observed in 20 (67%) of 30 haemophiliacs studied. The reason for this relatively low incidence in India, compared with 81–95% in the West, is probably attributed to the mode of treatment given. Single donor products are mostly given in India, rather than multi donor factor VIII concentrates given in the West.
Deficiency of endogenous prostanoids in gastric and duodenal ulcer diseases
Authors: ARAKAWA TETSUO , NAKAMURA HAJIME , SATOH HIROSHI , FUKUDA TAKASHI , SAKUMA HIROYUKI , KOBOYASHI KENZO
Published: March 2008

The levels of prostaglandin E2 (PGE2), 6‐keto‐prostaglandin F1α (PGF1α) and thromboxane B2 (TXB2) in endoscopic biopsy specimens from the gastric and duodenal mucosa of healthy volunteers and ulcer patients were measured by radio‐immunoassay. The PGE2 and PGF1α levels in the mucosa of the corpus of the stomach were lower and the TXB2 level was higher in 10 patients with gastric ulcer in the corpus than in the 16 healthy subjects. The PGE2 level in the antral mucosa of 14 patients with gastric ulcer in the antrum was lower than in the controls. In 18 patients with duodenal ulcer, PGE2 deficiency was more widespread in the entire gastric and duodenal mucosa while the reduced PGF1α level was limited in the gastric corpus. Lower levels of PGE2 in patients with antral or duodenal ulcer and of PGE2 and PGF1α in patients with corpus ulcer in the anatomical mucosal area including the ulcer site may predispose the mucosa to ulceration.
Effect of atropine on responses of exocrine pancreas and plasma cholecystokinin to intraduodenal amino acids in dogs
Authors: SHIBATA TOKIMUNE , HAYAKAWA TETSUO , KONDO TAKAHARU , SUGIMOTO YOSHIYUKI , KITAGAWA MOTOJI
Published: March 2008

The effect of atropine on responses of exocrine pancreas and plasma cholecystokinin (CCK) to intraduodenal mixed amino acids has been studied in conscious dogs with Thomas gastric and duodenal fistulae. Intraduodenal amino acids provoked significant increase of pancreatic protein output and of plasma CCK concentration. Atropine significantly reduced protein output only in the initial peak after amino acid administration. Atropine had no significant effect on plasma CCK. It is indicated that cholinergic nerves predominate in the early pancreatic protein response to intraduodenal amino acids and CCK prevails in the later phase, though these two factors do not seem to be the only factors responsible for the secretion.
A comparison between des‐γ‐carboxy prothrombin and α‐fetoprotein as markers of hepatocellular carcinoma in southern African Blacks
Authors: KING MICHAEL A. , KEW MICHAEL C. , KUYL JOHAN M. , ATKINSON PETER M.
Published: March 2008

Abstrat

Des‐γ‐carboxy prothrombin (DCP), a precursor of prothrombin, has been reported recently to be as good a marker, or even better, of hepatocellular carcinoma than α‐fetoprotein (α‐FP). The sensitivity, specificity and predictive values of the two markers have been compared in 98 southern African Blacks with hepatocellular carcinoma and in 120 Black controls with various diseases which might be mistaken clinically for this tumour: 32 with hepatic metastases, 33 with amoebic hepatic abscesses, and 55 with chronic hepatic parenchymal disease. DCP levels were measured using a chromogenic assay with Dispholidus typus venom and staphylocoagulase. The agreement between the two methods was excellent (r= 0.995). α‐FP concentrations were measured by radioimmunoassay. DCP levels were raised in 66 of 98 patients (67.3%) and α‐FP levels in 82 of 98 patients (83.7%) with hepatocellular carcinoma (P= 0.006). The specificity of DCP was also less than that of α‐FP, although the difference just failed to reach statistical significance (P= 0.085). The predictive values of both a positive and a negative test for DCP were significantly less than those for α‐FP (P= 0.047 and 0.048, respectively). When, in an attempt to eliminate false positive results, the diagnostic cut‐off level for DCP was increased from 1.5 to 5.0 mu/ml and that of α‐FP from 20 to 400 ng/ml, the differences between the two markers remained the same. If the two tests were used together, the number of false negative α‐FP results was reduced from 16.3% to 7.1% and the number of equivocal α‐FP results was reduced from 11.2% to 5.1%. It is concluded that DCP is less useful than α‐FP as a single marker of hepatocellular carcinoma in southern African Blacks. However, the two markers can be used together profitably.
Chylous ascites in cirrhosis: A case report and review of the literature
Authors: CHENG WENDY S. C. , GOUGH IAN R. , WARD MICHAEL , CROESE JOHN , POWELL LAWRIE W.
Published: March 2008

Abstrat

Chylous ascites is an uncommon clinical entity which results from the accumulation of fat, predominantly chylomicrons, in the ascitic fluid. Conventional treatment methods are unsatisfactory. A patient is reported with chylous ascites associated with cirrhosis and portal hypertension in whom the ascites, the renal insufficiency and the fluid and electrolyte disturbances were corrected by the insertion of a Denver peritoneovenous shunt.
A prospective evaluation of biopsy site in the diagnosis of gastric malignancy: The margin or the base?
Authors: LIN HWAI‐JENG , LEE FA‐YAUH , TSAI YANG‐TE , LEE SHOU‐DONG , LIN CHING‐YI , TSAY SHYH‐HAW , CHIANG HUNG
Published: March 2008

The diagnostic value of endoscopic biopsy from the ulcer margin (six specimens) and the base (six specimens) in 46 cases of gastric malignancy was evaluated. The biopsy positive rates for malignancy from the ulcer margin and the base were 42 of 46 (91.3%) and 37 of 46 (80.4%), respectively (P= 0.2312). The diagnostic positive rate was increased to 95.6% (44 of 46) when the results of 12 biopsy specimens obtained from the ulcer margin and the base were combined. The diagnostic positive rate was not statistically different when the morphology or the location of the gastric malignancy was considered. No complication of massive bleeding or perforation was found after both sites had been biopsied. It is concluded that the margin and the base of a gastric malignant ulcer are both suitable and diagnostically effective for endoscopic biopsy. If the ulcer margin of the gastric malignancy is difficult to approach, the ulcer base appears to be a satisfactory alternative site for endoscopic biopsy.
Applications of molecular genetics to gastrointestinal and liver diseases. I. Technical approaches
Authors: SUMMERS KIM M.
Published: March 2008

Recent developments in recombinant DNA techniques have allowed an understanding of the molecular genetics of many diseases, some affecting the gastrointestinal tract and liver. DNA probes which detect sequences within or near disease genes can be selected by direct approaches, if the gene product or primary gene function is known, or by indirect methods when the chromosomal location is known. Such probes have resulted in extensive family studies which can now define risks to family members of developing a genetic disease. The development of the polymerase chain reaction will also be of considerable use in clinical genetics and in the diagnosis of some infectious diseases. The techniques are summarized and examples of their use are given. A glossary of terms is also provided.
Experimental mesenteric ischaemia in sheep: Gut peptide release and haemodynamic changes
Authors: SOMJEN G. , FLETCHER D. R. , SHULKES A. , HARDY K. J.
Published: March 2008

Abstract Mesenteric ischaemia remains a frequently lethal condition. An improvement in survival is only likely with earlier diagnosis. Even with action upon early diagnosis and reestablishment of circulation, fatal shock often follows.

This study was designed to determine the possible role of gastrointestinal regulatory peptides in the haemodynamic pathophysiology of acute mesenteric arterial ischaemia and whether measurement of these peptides would have diagnostic potential.

Fourteen anaesthetized sheep were studied, seven with acute superior mesenteric artery (SMA) occlusion and seven with acute superior mesenteric and coeliac artery (SMA + CA) occlusion. Changes in peptide levels and haemodynamic changes were similar in the two experimental groups, but were more pronounced in the more severe ischaemia of SMA + CA occlusion.

No major changes in systemic plasma gastrin, pancreatic polypeptide, neurotensin and vasoactive intestinal polypeptide (VIP) occurred during ischaemia. There was, however, a fivefold increase in VIP in portal venous plasma during SMA + CA occlusion. In the reperfusion period there were increases in VIP concentrations in both systemic and portal circulations in both groups.

During ischaemia there was a rise in mean arterial pressure and peripheral resistance and a fall in cardiac output. Reperfusion was characterized by systemic and splanchnic vasodilation coincident with the rise in systemic plasma VIP. It is concluded that VIP which is released from the ischaemic intestine is likely to mediate a component of vasodilation seen during reperfusion.
Effect of smoking on gastric acid secretion in patients with duodenal ulcer
Authors: RAMESH G. N. , KOCHHAR R. , BROOR S. L. , GHOSH P. , SHARMA B. K. , MEHTA S. K.
Published: March 2008

Abstract The effect of smoking on gastric secretion was studied in 15 consecutive patients with duodenal ulcer – six normosecretors (basal acid output ≤ 3 mEq/h), and nine hypersecretors (basal acid output > 3 mEq/h). The volume, acid output, acid concentration, and pH of the gastric juice measured before, during and after 1 h of smoking did not show any significant difference in these patients taken as a single group, or when the normosecretors and hypersecretors were analysed as separate groups (P > 0.05 for each parameter in each group). The higher acid output before and during smoking in hypersecretors than in normosecretors was due to the higher acid concentration in the gastric juice (P < 0.01). Study of the pH curves of the gastric juice after acute smoking showed that hypersecretors had a lower pH for a longer duration compared with normosecretors. This could make the hypersecretors with a history of chronic smoking more prone to developing duodenal ulcer.
Ethanol‐induced gastric mucosal damage in the rat with Taenia‐stimulated hypertrophic gastropathy
Authors: CHO C. H. , PFEIFFER C. J.
Published: March 2008

Abstract The susceptibility to ethanol‐induced lesions was studied in rats with experimental hypertrophic gastropathy, in order to examine the nature of gastric mucosal resistance in this condition. Acute erosions were induced by a standard per os method of administration with graded concentrations of ethanol; underlying mucosal hypertrophic gastropathy was induced by infection with Taenia taeniaeformis. The gastric mucosal content of histamine and serotonin was also assessed. Hypertrophic gastropathy was characterized by mucus cell hyperplasia, greatly increased stomach weight, increased mucosal content of histamine, and no effect in resistance to gastric injury induced by graded doses of ethanol. Correlated changes in serotonin content with treatment were not observed, but mucosal histamine content was correlated inversely with ethanol administration in both parasite‐infected and non‐infected rats. This model of hypertrophic gastropathy could be of interest to study the pathogenesis of hypertrophic gastropathy and its response to known injurious agents.
Resected case of hepatocellular carcinoma associated with lupoid hepatitis
Authors: MOTOO YOSHIHARU , WAKATSUKI TOSHINOSUKE , TANAKA NOBUYOSHI , HINOUE YOSHINOBU , KOBAYASHI KENICHI , HATTORI NOBU , MATSUI OSAMU , IZUMI RYOHEI , NAKANUMA YASUNI , OHTA GOROKU
Published: March 2008

Abstract A 65 year old woman with lupoid hepatitis developed hepatocellular carcinoma which was diagnosed at an early stage. She had no history of blood transfusion and serum hepatitis B virus markers were negative. Prednisolone and 6‐mercaptopurine were administered for the treatment of lupoid hepatitis. A hepatocellular carcinoma was detected by the elevation of serum α‐fetoprotein and imaging studies. A tumour, 1.4 cm in diameter, was located in the lateral segment of the left hepatic lobe. It was resected by hepatic subsegmentectomy. Histological study showed a hepatocellular carcinoma of Edmondson type II against a background of posthepatitic cirrhosis. The patient was in good condition 2.5 years after the operation.
Progression of radiological changes in relapsing and chronic pancreatitis
Authors: KASUGAI TATSUZO , TANEHIRO KENJI , KURIMOTO KUMIKO , FUJIWARA KATSUHIKO , KUNO NOBUYOSHI
Published: March 2008

Abstract Progression of radiological changes was noted in 19 (22.1%) of 86 cases of relapsing or chronic pancreatitis followed by serial pancreatograms. The initial feature of chronic pancreatitis was focal minimal pancreatitis, characterized by an irregular dilatation of several side branches on the pancreatogram. Some patients with focal minimal pancreatitis demonstrated progression of the extent and severity of changes only in side branches while others progressed further to moderate or advanced chronic pancreatitis showing changes in the main pancreatic duct. Most of the progressive cases were alcoholic, and some showed progression to advanced pancreatitis within 4 years. Rapid progression of radiological changes was associated with relapses of acute pancreatitis. No remarkable changes were observed in many non‐alcoholic patients, whereas some cases complicated with gallstones showed progression of disease in the side branches during a follow‐up period of 3–7 years.
Study of hepatic venous wedge and intraperitoneal pressures in cirrhotic patients with refractory ascites treated by dialytic ultrafiltration
Authors: LAI KAR NENG , PUN CHIU ON , LEUNG JOSEPH W. C.
Published: March 2008

Abstract Three cirrhotic patients with intractable ascites and one patient with malignant ascites received dialytic ultrafiltration of ascitic fluid by a haemofilter system for symptomatic relief. The haemofilter removes fluid and substances with a molecular weight less than 50 000 daltons and the concentrated ascitic fluid was reinfused into the pertioneal cavity after ultrafiltration. The changes in intraperitoneal and hepatic venous wedge pressures were studied in these patients. Dialytic ultrafiltration of ascites was associated with a parallel fall of both intraperitoneal and hepatic venous wedge pressures in cirrhotic patients but not in the patient with malignant ascites. The intraperitoneal and hepatic venous wedge pressures remained low for 18 h after completion of dialytic ultrafiltration. The mean arterial pressure and central venous pressure remained unchanged despite rapid removal of ascitic fluid. The interrelationships between the intraperitoneal pressure, hepatic venous wedge pressure, and vascular volume are discussed.
Hepatocellular carcinoma in cirrhotic liver in Trieste
Authors: MELATO MAURO , VALENTE MATTEO , MUCLI EZIO , MUUSE MAXAMED MACALLIN , TARAGLIO STEFANO
Published: March 2008

One hundred consecutive cases of hepatocellular carcinoma (HCC) in cirrhosis observed at autopsy were studied and their pathological aspects were compared with those reported in the literature. The results, which are representative of HCC epidemiology in a geographical area where cirrhosis is mostly due to alcohol abuse, show that similarities in the architectural pattern of HCC and weight of the liver exist between our material and samples with different aetiology and epidemiology. A relationship between the histological grade of HCC and its propensity to metastasize was demonstrated. The reported better prognosis of clear cells per se could not be confirmed, although clear cell HCC occurred exclusively in grade 2. It was also demonstrated that the relationship between grading and staging was strongly influenced by the association of HCC with cirrhosis, which is a fact that is usually overlooked by the common staging (and grading) methods.
Biological potency of neurotensin metabolites in vivo: Importance of alcohol ‘fixation’ of blood
Authors: SHULKES ARTHUR , FLETCHER DAVID R. , HARDY KENNETH J.
Published: March 2008

Neurotensin (NT), a 13‐amino acid peptide, is released from the ileum following a meal. It is metabolized principally by the kidney and in the circulation to N‐terminal fragments and apparently rapidly degraded C‐terminal fragments. The present study was designed to compare the biological activity (plasma pancreatic polypeptide response) and the clearance kinetics of NT(1‐13), the N‐terminal fragment NT(1‐11) and the C‐terminal fragment NT(8‐13). To measure accurately the circulating concentrations of short‐lived NT fragments in the circulation, a method was devised of collecting blood directly into alcohol (‘alcohol fixation’).
Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients
Authors: EBARA MASAAKI , OHTO MASAO , SUGIURA NOBUYUKI , KITA KAZUHIKO , YOSHIKAWA MASAHARU , OKUDA KUNIO , KONDO FUKUO , KONDO YOICHIRO
Published: March 2008

Abstract Percutaneous ethanol injection (PEI) was applied to 120 lesions in 95 patients with hepatocellular carcinomas (HCC) smaller than 3 cm in the past 6 years. All main target tumours, in 67 patients who had been followed by sonography for more than 6 months after PEI, decreased in size; 28 tumours (41.8%) became undetectable and have remained so until now. The 1‐, 2‐, 3‐, 4‐ and 5‐year survival rates calculated by the Kaplan‐Meier method were 93%, 81%, 65%, 52% and 28% respectively. These survival rates were better than those of patients with HCC smaller than 3 cm who did not receive anticancer treatment (P <0.01). The survival of patients of the Child's A or Child's B status was better than that of those with Child's C disease. Recurrence occurred in areas within the liver different from the original lesion in 34% in one year, 61% in two years and 66% in three years after PEI. PEI was then repeated in 61% of such patients.
Primary biliary cirrhosis: clinicopathological characteristics and outcome
Authors: JEFFREY GARY P. , REED WILLIAM D. , SHILKIN KEITH B.
Published: March 2008

AbstractThirty‐five patients with primary biliary cirrhosis were seen between 1974 and 1989. The median mean age at presentation was 53 years (range: 30–77) and the female to male ratio was 7.8:1. Thirteen (37%) were asymptomatic and nine (26%) had associated auto‐immune disorders. Pruritus and hepatomegaly were present in half of the patients. Advanced histological stages of disease (Stages 3 and 4) were present in 57% of patients. The median period of follow‐up was 5 years (range: 0.1–20). Twelve patients died, nine from hepatic causes and three from non‐hepatic causes. One has undergone liver transplantation. A Kaplan‐Meier curve estimated the median survival to be 11 years. Asymptomatic patients developed progressive disease and survival was similar to that of symptomatic patients. Using Cox's proportional hazards model, age, serum bilirubin and serum albumin were found to be independent prognostic variables correlating with reduced survival.
The ‘mosaic‐like’ pattern of portal hypertensive gastric mucosa after variceal eradication by sclerotherapy
Authors: KOTZAMPASSI K. , ELEFTHERIADIS E. , ALETRAS H.
Published: March 2008

Abstract The ‘mosaic‐like’ pattern of portal hypertensive gastric mucosa has been evaluated endoscopically in 38 patients referred for elective sclerotherapy, before the first session, after the complete eradication of varices and six months later. Of 38 patients studied, 18 patients exhibited mild, and 20 patients exhibited negative, findings of congestive gastropathy prior to sclerotherapy. Seventeen and 18 patients, respectively, developed aggravated changes of congestive gastropathy after the completion of sclerotherapy (P=0.003). We consider that obliteration of varices by means of endoscopic sclerotherapy influences the development of gastric congestion changes in the majority of patients. However, further studies are required to relate the direction of blood flow in the portal system as well as the level of portal pressure with the congestive gastropathy findings in such patients.
Polymeric IgA antibody to gliadin in the serum of patients with coeliac disease
Authors: BARTHOLOMEUSZ R. C. A. , LABROOY J. T. , DAVIDSON G. P. , HETZEL P. , JOHNSON R. B. , SHEARMAN D. J. C.
Published: March 2008

Abstract Secretory component (SC) binding assays which detect polymeric IgA (pIgA) in serum were used to measure serum antigliadin pIgA and total pIgA in patients with coeliac disease. Total IgA antigliadin antibody in serum and intestinal fluid was measured by enzyme linked immunosorbent assay (ELISA). The relationship of pIgA antibody to dietary gluten and the antigliadin IgA antibody in intestinal fluid was examined.

Twenty‐nine serum samples were assayed, twelve from patients ingesting gluten and seventeen from patients who had excluded gluten from their diet for 6 months. Eight of these were paired samples from 4 adults on and off gluten. In addition, paired samples of both intestinal fluid and serum were obtained from 7 children on and off gluten.

Polymeric IgA antibody to gliadin was detected in 11 of 12 subjects on gluten but in only 3 of 17 who had excluded gluten. Three of the four adults from whom paired serum samples were obtained had pIgA antigliadin, but only while on gluten. Three of the seven children in whom intestinal and serum antibody were assayed had pIgA to gliadin, which could not be detected after exclusion of gluten, although their intestinal antibody level remained elevated. There was no change in total pIgA levels with diet although the levels were higher than those seen in normal subjects.

We conclude that pIgA antibody to gliadin is frequently found in the serum of coeliac patients ingesting gluten. It disappears with gluten elimination at a time when the IgA antigliadin antibody in intestinal fluid has not altered.
Quantitative study of apoptosis in normal rat gastroduodenal mucosa
Authors: Benedetti Antonio , Mancini Raniero , Marucci Luca , Paolucci Franca , Jezequel Anne Marie , Orlandi Francesco
Published: March 2008

The occurrence of apoptosis in the normal gastrointestinal mucosa has been given little consideration until now, although the phenomenon may be of interest in the light of recent hypotheses about its role in physiological cell renewal. In the present study, a quantitative evaluation conducted on normal gastric and duodenal mucosa of young rats has shown that apoptosis is a rare but constant phenomenon: 1.4±1.1 (mean±1 s.d.) apoptotic bodies were observed within the surface epithelium of single gastric pits and 3±1 in duodenal villi. In both situations, the apoptosis showed a preferential localization in the juxtaluminal segments of the epithelium. This phenomenon appears distinct from passive exfoliation of mucosal cells and, as an expression of ‘programmed cell death’, it is likely to contribute to the normal intestinal epithelial cell turnover.
Antibody to herpes simplex virus type 1 in peptic ulcer patients
Authors: KANG J. Y. , LEE T. P. , GUAN R. , TAY H. H. , YAP I. , MATH M. V.
Published: March 2008

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race‐, sex‐and age‐matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.
Case‐control study on oesophageal cancer in southern Thailand
Authors: CHONGSUVIVATWONG VIRASAKDI
Published: March 2008

A case‐control study was conducted in southern Thailand to test the hypothesis that alcohol consumption, smoking, rubber processing and nutritional deficiency were risk factors for oesophageal cancer. Cases (n= 40) were recruited from patients admitted to the University Hospital, where the first interview took place. Age‐ and sex‐matched controls (n= 129) were selected from closest neighbours of the case. The case: control ratio varied from 1:1 to 1:6, depending on the availability of controls. Logistic regression analysis gave a relative risk for drinking and smoking of 5.7 (95% confidence interval (CI) = 2.1–15.1), whereas the relative risk for alcohol drinking only was 4.7 (95% CI = 0.5–42) and for smoking only was 1.6 (95% CI = 0.7–4). Data on dietary habits were not analysed because of great variation. Rubber processing was not a significant risk factor. It was concluded that combined alcohol and cigarette consumption are important risk factors for oesophageal cancer in southern Thailand.
Peritoneal absorption of pancreatic enzymes in bile‐induced acute pancreatitis in dogs
Authors: SUGIMOTO YOSHIYUKI , HAYAKAWA TETSUO , KONDO TAKAHARU , SHIBATA TOKIMUNE , KISHIMOTO WAKAHIKO
Published: March 2008

To clarify the contribution of peritoneal absorption of enzyme‐rich exudate to the persistent elevation of serum amylase in bile‐induced pancreatitis in dogs, serum amylase, lipase and immunoreactive trypsin (IRT) levels were measured during 24 h after induction of pancreatitis with and without peritoneal lavage. The basal level of serum amylase activity (m±s.e. = 1291 ± 111 U/L) reached a plateau at 30 min (2688 ± 185) after induction of pancreatitis and continued to rise until 24 h (7201 ± 424). This persistent amylase elevation could be reduced significantly by peritoneal lavage. Serum IRT rose to a peak (378 ± 103 ng/mL) at 30 min from the basal (20 ± 5), then decreased until 3 h (211 ± 34) and maintained a consistent level thereafter. Serum lipase elevation took an intermediate course between the levels of serum amylase and IRT. Intraperitoneal injection of 5 mL pancreatic juice could reproduce similar elevations to those of the respective enzymes, except lipase, seen in pancreatitis. These results suggest that transperitoneal absorption of pancreatic enzymes contributes to the elevation in serum enzyme levels and that rates of peritoneal absorption and serum disappearance differ from enzyme to enzyme.
Ispaghula therapy in irritable bowel syndrome: Improvement in overall well‐being is related to reduction in bowel dissatisfaction
Authors: JALIHAL ANAND , KURIAN GEORGE
Published: March 2008

This placebo controlled, double‐blind, cross‐over trial involving 20 patients was conducted to assess the effect of ispaghula husk on the major bowel symptoms and the whole gut transit time in irritable bowel syndrome (IBS) and to determine if changes in these parameters were related to global improvement. All 20 patients were interviewed at the end of the treatment periods and 14 patients kept concurrent daily records. Ispaghula therapy resulted in improvement in global symptoms and satisfying bowel movements (P < 0.001) but produced no change in abdominal pain or flatulence. There was a correlation between the improvement of well‐being and the number of days of satisfying bowel movements (P < 0.001) but not with the indexes of pain, stool frequency or changes in the transit time. The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of ispaghula in IBS.
Rapid diagnosis of Campylobacter pylori infection by urea test paper
Authors: Zhong Yu , Xiancun Zhao , Hong Yu , Shengyi Jin
Published: March 2008

Antral biopsy specimens from 106 patients were examined by culture, Gram stain and silver stain for Campylobacter pylori. Biopsies were also examined by a urea test paper test (UTPT). Of 106 patients studied C. pylori was detected in 68 (64.2%) by Gram stain, silver stain and culture. The UTPT was positive in 63 (59.4%) specimens. Five had false negative results using the UTPT with no false positive subjects. Thus, UTPT has a sensitivity of 92.6% (63/68) and a specificity of 100%. Of the 63 specimens that were UTPT positive, 45 were positive within 1 min, 58 were positive within 5 min. The remainder became positive between 5 and 15 min. There was a negative correlation between the time required for positive UTPT and the number of C. pylori per pit as seen on silver stained sections (P < 0.05). UTPT is a rapid and sensitive method for detecting C. pylori in gastric mucosa. This enables early therapy, if indicated, before discharge from hospital. Moreover, the urea test paper method is cheap and easily stored.
Kupffer cell functions during intestinal amoebiasis in guinea pigs
Authors: VIRK K. J. , GANGULY N. K. , PRASAD R. N. , DILAWARI J. B. , MAHAJAN R. C.
Published: March 2008

Kupffer cells play an important role in all alimentary tract infections. Their role in intestinal amoebiasis is not clear. Hence, the present study examined Kupffer cell functions—phagocytic capacity and levels of a key lysosomal enzyme, N‐acetyl‐β‐glucosaminidase—in guinea pigs infected with Entamoeba histolytica intracaecally. Animals were sacrificed on days 0, 3, 7, 14 and 21 post‐infection. During intestinal amoebiasis the phagocytic capacity of Kupffer cells was depressed, whereas lysosomal enzyme levels were highly elevated. Maximum alteration in Kupffer cell functions was observed on the 14th post‐infection day (P < 0.01). Animals which survived until 21 days post‐infection did not show any significant (P > 0.05) change in their Kupffer cell functions compared with controls and day zero values. Phagocytic capacity was inversely correlated with severity of caecal lesions. In contrast, enzyme levels were directly correlated with degree of caecal lesions. Similar trends were observed in blood monocytes. The depressed phagocytic capacity of mononuclear phagocytes and the increased enzyme release by these cells accompanying intestinal amoebic infection may contribute to the establishment of the infection and the tissue damage that accompanies it.
Extracorporeal shock wave lithotripsy for bile duct stones: An Australian experience
Authors: MERRETT M. N. , DESMOND P. V.
Published: March 2008

Choledocholithiasis requires prompt therapy, particularly if complicated by ascending cholangitis. Endoscopic sphincterotomy with balloon and basket extraction clears the bile duct in 90% of patients. Failure is usually associated with large stones, that is, > 2 cm. Until recently such patients would have required surgical intervention. In 1986 St Vincent's Hospital installed a Dornier HM3 Lithotriptor to be used for both urinary tract and bile duct calculi. A retrospective analysis of patients referred for extracorporeal shock wave lithotripsy (ESWL) to bile duct stones was performed. There were 47 patients (28 female, 19 male) with an average age of 76 years. Twenty‐two patients had a single stone with a mean diameter of 2.4 cm and 25 had multiple stones. In two patients the stone was not able to be visualized, so ESWL could not be performed. Complete stone clearance was achieved without further intervention in 13 patients, and in a further 23 after endoscopic extraction of fragments. In five patients only partial duct clearance was achieved. However, this provided palliation and enabled the patient to be discharged. Surgical intervention was required in the remaining four cases. Overall success rate was 80% with a further 11% being palliated with improved biliary drainage. There were no serious adverse effects from ESWL. All patients were discharged from hospital. Mortality at 30 days was 4.7% and at 6 months was 19.4%. One patient succumbed to ascending cholangitis 22 weeks post‐ESWL (2.7%). All other deaths were unrelated to ESWL or biliary disease. We conclude that ESWL is a safe and effective treatment for bile duct stones not amenable to endoscopic extraction.
Defective immunological functions associated with abnormal lymphokine‐activated killer activity in patients with hepatocellular carcinoma
Authors: SHIRAI MUTSUNORI , WATANABE SEISHIRO , NISHIOKA MIKIO
Published: March 2008

The in vitro lymphokine‐activated killer (LAK) activity of peripheral blood mononuclear cells (PBMC) from 36 patients with hepatocellular carcinoma was investigated. The activity was greatly diminished in 13 patients and enhanced in seven patients. A flow cytometric study showed that the percentage of OKM1+, Leu‐7+ 11b+, and Leu‐7− 11b+ fractions in PBMC was decreased and the percentage of OKT8+ and Leu7+11− fractions was increased significantly in the 13 patients with lower LAK activity, compared with the values of the seven higher LAK activity patients. Furthermore, the response of PBMC to interleukin‐2 (IL‐2) was deficient in the lower activity group. However, there was no significant difference in IL‐2 production by PBMC, IL‐2 receptor (p55) expression of PBMC and mitogen (Con‐A, PHA) response of PBMC between the two groups. These findings indicate the possibility that diminished LAK activity in hepatoma patients is due to a decreased number of LAK precursor cells and a defective response of LAK precursor cells to IL‐2.
Iatrogenic superior mesenteric arteriovenous fistula: Ultrasonographic, CT and angiographic features and histological findings of the liver biopsy
Authors: IWAI MASAKI , KASHIWADANI MOTOMU , SUYAMA YOSHIKAZU , MIYOSHI MASATO , KASHIMA KEI
Published: March 2008

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.
Antipyrine elimination test as a guideline for selecting patients for transhepatic biliary drainage
Authors: RAMESH V. S. V. , KOCHHAR R. , GARG S. K. , WIG J. D. , GUPTA N. M.
Published: March 2008

Antipyrine elimination halflife (AP t1/2) was studied in 18 patients with obstructive jaundice along with routine liver function tests 24–48 h before the expected time of percutaneous transhepatic biliary drainage (PTBD). To see if it is possible to predict the outcome of PTBD, various predrainage parameters were correlated with the postdrainage bilirubin clearance after 1 week of drainage. Predrainage AP t1/2 correlated best with bilirubin clearance (r= 0.775, P <0.01) compared with predrainage serum bilirubin, alkaline phosphatase and serum proteins/albumin. Eight patients had AP t1/2 < 15 h, while 10 had AP t1/2 15 h. Patients with AP t1/2 < 15 h had significantly faster recovery after PTBD than patients with AP t1/2 > 15 h. If PTBD can be restricted to those with AP t1/2 < 15 h, the advantages of preliminary PTBD can be achieved with minimum complications. Thus, estimation of AP t1/2 may aid in the selection of patients with obstructive jaundice who are likely to benefit by preliminary biliary decompression.