bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Helicobacter pylori infection and gastric metaplasia in the duodenal bulb in the pathogenesis of duodenal ulcer
Authors: Futami Hajime , Takashima Misako , Furuta Takahisa , Hanai Hiroyuki , Kaneko Eizo
Published: March 2003

Background: The aim of this study was to determine whether the amount of Helicobacter pylori and the extent of gastric metaplasia in the duodenal mucosa play critical roles in the pathogenesis of duodenal ulcer.

Methods: Duodenal and gastric biopsy specimens were obtained from H. pylori‐positive patients with duodenal ulcer, gastric ulcer or chronic gastritis. The extent of gastric metaplasia was evaluated histologically and endoscopically using the methylene blue test. In this study, we performed competitive polymerase chain reaction, a highly sensitive and quantitative method for determining the amount of H. pylori gastric and duodenal mucosa. The prevalence and extent of gastric metaplasia and the amount of H. pylori in the duodenal bulb in the three patient groups were compared. The correlation between the amount of H. pylori in the duodenum and gastric antrum and extent of gastric metaplasia were also determined.

Results: The prevalence and extent of gastric metaplasia and the amount of H. pylori in the duodenal bulb in patients with duodenal ulcer were much higher than in patients with gastric ulcer or chronic gastritis. A positive correlation was found between the amount of H. pylori in the duodenum and the extent of gastric bulb and that in the antrum.

Conclusions: The findings of this study indicate that H. pylori colonization in the duodenal bulb may play a critically important role in the pathogenesis of duodenal ulcer and that the amount of H. pylori in the duodenal bulb may be related to the amount of H. pylori in the gastric antrum and the extent of gastric metaplasia in the duodenal bulb.
Clinical evaluation of endoscopic injection sclerotherapy using n‐butyl‐2‐cyanoacrylate for gastric variceal bleeding
Authors: Ogawa Kenji , Ishikawa Shinya , Naritaka Yoshihiko , Shimakawa Takeshi , Wagatsuma Yoshihisa , Katsube Akao , Kajiwara Tetsuro
Published: March 2003

Background: Emergency endoscopic injection sclerotherapy (EIS) has been applied to the initial treatment of gastric variceal bleeding and various methods have been attempted.

Methods: Emergency EIS was performed on 38 patients with gastric variceal bleeding using either the ethanolamine oleate (EO) method or n‐butyl‐2‐cyanoacrylate (Histoacryl) method and the outcome was compared.

Results: Complete haemostasis was defined as continuous haemostasis lasting for 14 days or more. Complete haemostasis was achieved in 52.4% of patients in the EO method versus 100% of those treated with the Histoacryl method, a significant difference, suggesting that the Histoacryl method was superior for achieving haemostasis in an emergency. The cumulative non‐bleeding rate was also significantly higher in patients treated with Histoacryl, indicating the durability of haemostasis. There were no serious complications in patients who received either method of sclerotherapy. Post‐EIS surgery was required in 42.8% of patients treated with EO, while no surgery was required in those treated with Histoacryl, supporting the greater haemostatic effect of Histoacryl. Although there was no significant difference in the cumulative survival rates of patients treated by these two methods, death from haemorrhage was avoided by using Histoacryl.

Conclusions: Based on these results, the Histoacryl method is thought to be the initial treatment of choice for gastric variceal bleeding, because it achieved superior haemostasis compared with EO and death by haemorrhage was avoided.
Cholestasis of pregnancy
Authors: McDonald Jennifer
Published: March 2003

Cholestasis of pregnancy is the commonest liver disease unique to pregnancy and is characterized by pruritus in the mother in late pregnancy, without any skin rashes. This is accompanied by an elevation of the serum bile acids. Liver function test abnormalities may occur. Abdominal pain is not a feature and liver failure does not occur. The diagnosis is made by a suggestive history and exclusion of other causes by the history, serology and an upper abdominal ultrasound. All symptoms and signs should disappear within 4 weeks post‐partum; prolonged post‐partum courses should prompt a search for other causes, such as primary biliary cirrhosis. The syndrome is associated with a five‐fold increased incidence of stillbirth, intra‐partum foetal distress and pre‐term labour. The reason is not clear and not predictable. The accepted management is induction or delivery at 38 weeks, which has led to a reduction in poor foetal outcome. Preliminary studies using ursodeoxycholic acid show symptomatic and biochemical improvement in most women treated. There is also a suggestion of an improved foetal outcome and treatment should be considered in women who present with the condition earlier in pregnancy.
Tauroursodeoxycholic acid enhances phagocytosis of the cultured rat Kupffer cell
Authors: Funaoka Masato , Komatsu Masafumi , Toyoshima Itaru , Mikami Kenichiro , Ono Tsuyoshi , Hoshino Takao , Kato Junji , Kuramitsu Tomoyuki , Ishii Tohru , Masamune Osamu
Published: March 2003

Background: Ursodeoxycholic acid is used in the treatment of acute and chronic intrahepatic cholestasis because it ameliorates cholestasis and protects hepatocytes. However, few studies have examined the effect of bile acids on the function of Kupffer cells.

Methods: The effect of various bile acids on cultured rat Kupffer cells was studied in terms of phagocytic activity in response to latex particles and morphological alterations. Video‐enhanced differential interference contrast microscopy was used.

Results: Taurochenodeoxycholic acid and taurodeoxycholic acid reduced the number of latex particles incorporated into Kupffer cells, but taurocholic and tauroursodeoxycholic acids enhanced phagocytosis of latex particles. Inhibition of phagocytosis by taurochenodeoxycholic acid or taurodeoxycholic acid was essentially dose dependent. Tauroursodeoxycholic acid also enhanced phagocytosis by Kupffer cells in which phagocytosis had been reduced by pretreatment with taurochenodeoxycholic acid or taurodeoxycholic acid. Incorporated latex particles had a distinct translocation speed of 0.084 ± 0.024 μm/s (mean maximum speed ± SD); the speed was in the same range with tauroursodeoxycholic acid treatment. Tauroursodeoxycholic acid induced a 56% expansion of cytoplasm, associated with increased ruffling and movement of intracellular organelles.

Conclusions: These observations suggest that tauroursodeoxycholic acid enhances membrane trafficking without changing translocation speed.
C ASE R	EPORT: Percutaneous drainage of the pancreatic head hydatid cyst with obstructive jaundice
Authors: Yattoo Ghulam Nabi , Khuroo Mohammad Sultan , Zargar Showkat Ali , Bhat Fayaz Ahmad , Sofi Bashir Ahmad
Published: March 2003

We report a rare case of a patient with a primary hydatid cyst in the head of the pancreas who presented with obstructive jaundice caused by extrinsic compression of the intrapancreatic portion of the bile duct. The patient was treated successfully by ultrasound‐guided percutaneous drainage of the cyst using hypertonic (20%) saline as the scolicidal agent and albendazole chemoprophylaxis before and after the drainage. The cyst was not visible on ultrasonography at 6 months follow up. Clinical, sonographic and serological follow up to 35 months showed no evidence of cyst recurrence or dissemination. In endemic areas of hydatid disease, hydatid cyst should be a differential diagnosis in cystic lesions of the pancreas in patients presenting with obstructive jaundice.
C ASE R	EPORT: Mucinous cholangiocarcinoma featuring a multicystic appearance and periportal collar in imaging
Authors: Mizukami Yusuke , Ohta Hitoyoshi , Arisato Satoshi , Nakano Yasuhiro , Murakami Masanori , Orii Yutaka , Saito Hiroya , Sakurai Yasuo , Sakurai Hiroharu , Sato Teiko , Uno Yuji , Nakanuma Yasuni , Ohhira Motoyuki , Kohgo Yutaka
Published: March 2003

A case of mucinous cholangiocarcinoma (CC), a rare histological type of CC, featuring unusual images is reported. The patient was hospitalized because of acute development of jaundice and fever. Computed tomography demonstrated multiple cystic lesions in the liver and a band‐like low density area parallel to the intrahepatic portal vein, a so‐called ‘periportal collar’. Endoscopic cholangiography revealed a stricture of the hepatic duct with slight upstream dilatation. Cytology of the bile juice and fine‐needle aspiration of the cystic lesion in the liver disclosed mucinous carcinoma. The patient died of multiorgan failure 3 weeks after admission. The autopsied liver showed that multiple mucus lakes were lined with adenocarcinoma cells and signet ring cells were floating in the mucus lakes. The cancer cells had spread along the portal tract and invaded into the hepatic parenchyma.

© 1999 Blackwell Science Asia Pty Ltd
Characterization of antibody responses against rectal mucosa‐associated bacterial flora in patients with ulcerative colitis
Authors: Matsuda H , Fujiyama Y , Andoh A , Ushijima T , Kajinami T , Bamba T
Published: March 2003

Background
: Previous reports on faecal microflora have demonstrated that the total number of aerobes and coliforms was increased in patients with ulcerative colitis (UC). Based on the hypothesis that the pathogenesis of UC may be closely associated with the mucosal microflora, we investigated alterations in the mucosa‐associated microflora of UC patients.

Methods and Results
: The bacterial counts for both aerobes and anaerobes increased in UC patients. In particular, we detected the highest bacterial counts of Bacteroides vulgatus and these bacteria were isolated most frequently. In addition, we also investigated the serum antibody responses against the bacteria isolated from the affected mucosa by serum bacterial agglutination tests and immunoblotting. A high agglutination titre against B. vulgatus, Bacteroides fragilis, and Clostridium ramosum was detected in most UC patients, and the percentage of positive immunoreactivity was much higher in UC patients than in healthy controls. From the results of the immunoblotting, a unique antigenic determinant of B. vulgatus (BV43–26), a 26‐kDa protein from the outer membrane, was discovered. The serum immunoreactivity (immunoglobulin (Ig) G) against this 26‐kDa protein was much higher in UC patients (53.8%) than in the control sera (9.1%). The serum immunoreactivity (IgG) against a 50‐kDa protein isolated from the whole cell protein of Escherichia coli (EC48‐1) was also higher in UC patients (29.2%) than in normal controls (6.3%).

Conclusions
: These results suggest that B. vulgatus and a specific antibody response directed against it may play an important role in the pathogenesis of UC.
Effect of hepatobiliary disease, chronic hepatitis C and hepatitis B virus infections and interferon‐α on porphyrin profiles in plasma, urine and faeces
Authors: Gibson Peter R , Grant Janine , Cronin Virginia , Blake Dennis , Ratnaike Sujiva
Published: March 2003

Background
: Documentation of the profiles of porphyrins in hepatobiliary disease is limited. Strong associations of hepatitis B and C virus infections with porphyria cutanea tarda have suggested causal relationships. This study aimed to determine the nature of porphyrin abnormalities in hepatobiliary disease and the effect of interferon‐α on porphyrin profiles.

Methods
: Total porphyrins were measured in the plasma, urine and faeces of 83 patients with hepatobiliary disease (37 hepatitis C, 20 hepatitis B, 26 other causes) and 12 clinical controls, and porphyrin profiles were determined by high‐performance liquid chromatography.

Results
: Porphyrins were elevated in the plasma of 11 and urine of 23 patients with hepatobiliary disease, as a result of elevated coproporphyrin I. This was reflected in increased coproporphyrin I:III ratios. Abnormal total porphyrin levels had a significant negative correlation with plasma albumin, and a positive correlation with bilirubin and alkaline phosphatase, but not with aminotransferases. Total urinary porphyrins were elevated in three control patients, but coproporphyrin I:III ratios were normal. Although not seen in plasma or urine, porphyrins that are specific for porphyria cutanea tarda were found in the faeces of six patients, but this occurred with similar frequency in hepatitis B or C infection (four of 50) as in the clinical controls (two of 12). Interferon‐α had no effect during or after therapy in six patients with hepatitis C.

Conclusions
: Reduced biliary excretion of coproporphyrin I occurs in more severe cholestasis and/or hepatic dysfunction. A causal relationship between viral liver disease and porphyria cutanea tarda which is unlikely to be precipitated by interferon‐α, is not supported.
Interferon treatment is not associated with a worsening of psychiatric symptoms in patients with hepatitis C
Authors: Mulder Roger T , Ang Michael , Chapman B , Ross Alison , Stevens Isabel F , Edgar Christine
Published: March 2003

Aim
: To study prospectively the psychiatric side effects of interferon‐α in patients with hepatitis C.

Methods
: Sixty‐three consecutive patients at a hepatitis clinic were recruited. All were assessed using a psychiatric interview (SCID) and monitored using a self‐reporting psychiatric symptom questionnaire (SCL‐90).

Results
: Patients on interferon did not suffer a drop in mood or an increase in anxiety or irritability. The subgroup with past depression also did not suffer an increase in depressive symptoms. No patients attempted suicide.

Conclusions
: The risk of serious psychiatric symptoms when being treated with interferon‐α may not be high. Psychiatric illness or the possibility of psychiatric complications should not be used as a reason to refuse this treatment to patients with hepatitis C.

© 2000 Blackwell Science Asia Pty Ltd
Pancreatic vasoactive intestinal polypeptide‐oma as a cause of secretory diarrhoea
Authors: Masel Sharon L , Brennan Barbara A , Turner J Harvey , Cullingford Graham L , Cullen Digby J
Published: March 2003

A 42‐year‐old woman presented with a 4‐year history of worsening diarrhoea that was watery, profuse and confirmed to be secretory in nature. She had tested positive for phenolphthalein on urinary laxative screening but continued to deny laxative usage. Her vasoactive intestinal polypeptide (VIP) level was subsequently found to be markedly elevated. Despite a normal abdominal ultrasound, a computed tomography scan revealed a 5‐cm pancreatic tail mass. Octreotide scanning was used to exclude metastatic disease and she went on to have surgical removal of a localized pancreatic vasoactive intestinal polypeptide‐oma which resulted in the complete resolution of her diarrhoea.
Mucosectomy for gastric cancer: Current status in Japan
Authors: Tada Masahiro , Tanaka Yoshiyuki , Matsuo Naoki , Shimamura Tomotaka , Yamaguchi Kensei
Published: March 2003

Advances in techniques of image diagnosis have enabled the detection of minute or small cancer lesions in the stomach. Patients with such cancer, in principle, were treated surgically, but accumulated histopathological data on surgical cancer specimens revealed that many of these patients did not have any metastatic lesions. For those localized cancers, local treatment of primary lesions by endoscopy gives curative results. It has been demonstrated that endoscopic therapy is curative in mucosal well‐differentiated adenocarcinoma not more than 20 mm in diameter without ulceration. Efforts to cure early gastric cancer without surgery yielded fruitful results and a new treatment concept was established. Even if there is a recurrence of the residual or metachronous lesions, they can be treated by further endoscopic treatment.
Efficacy of a 1‐week pantoprazole triple therapy in eradicating Helicobacter pylori in Asian patients
Authors: Goh Kl , Parasakthi N , Cheah Pl , Ranjeev Ck , Rosmawati M , Tan Ym , Chin Sc
Published: March 2003

Background
: The aim of the present paper was to determine the efficacy and tolerability of a 1‐week treatment regimen consisting of pantoprazole and two antibiotics: clarithromycin and amoxycillin, in the eradication of Helicobacter pylori.

Methods
: The patients selected had unequivocal evidence of H. pylori infection based on urease test, culture and histology on antral and corpus biopsies obtained at endoscopy. Patients received pantoprazole 40 mg twice a day, clarithromycin 500 mg twice a day and amoxycillin 1 g twice a day for 1 week and were assessed for successful eradication at least 4 weeks after completion of therapy by repeat gastroscopy and gastric biopsies. Eradication was defined as absence of bacteria in both antral and corpus biopsies tested by culture, histology and urease test.

Results
: One hundred and six patients were recruited for the study. The mean age was 48.0 years (range: 23–74 years). Four patients defaulted follow up and five patients were not compliant (taking less than 85%) with medications. Eradication rates on per‐protocol analysis were: 88/97 (90.7%; 95% CI: 83.1–95.7); and on intention‐to‐treat analysis they were: 88/106 (83.0%; 95% CI: 75.9–90.2). Side‐effects were in general mild and tolerable: 57 of 106 (53.7%) patients complained of a bitter taste; 15 (14.1%) complained of giddiness; 10 (9.4%) complained of increased abdominal pain; 11 (11.5%) complained of lethargy and 16 (15.1%) complained of loose motions. Pre‐treatment metronidazole resistance was encountered in 57/74 strains (77.0%). Clarithromycin resistance was not encountered in any of the strains.

Conclusions
: The pantoprazole 1‐week triple therapy with amoxycillin and clarithromycin is effective in H. pylori eradication. The treatment was well tolerated by patients. Metronidazole resistance was reported in a high percentage of strains isolated from patients. Clarithromycin resistance was, however, not detected in any of the strains.
Novel targets for the pharmacotherapy of diarrhoea: A view for the millennium
Authors: Farthing Michael JG
Published: March 2003

Abstract Acute diarrhoea continues to carry a high morbidity and mortality worldwide. Intestinal infection is the major cause of acute diarrhoea although the prevalence of individual pathogens varies according to geographic location. In many countries in the industrialized world, reports of intestinal infections continue to increase; these are largely related to waterborne and foodborne outbreaks. Acute diarrhoea may be due to increased intestinal secretion, commonly as a result of infection with enterotoxin‐producing organisms (enterotoxigenic Escherichia coli, Vibrio cholerae) or to decreased intestinal absorption from infection with organisms that damage the intestinal epithelium (enteropathogenic E. coli, Shigella sp., Salmonella sp.). Although oral rehydration therapy has reduced the mortality associated with acute diarrhoea, the diarrhoea attack rate remains unchanged and stool volume often increases during the rehydration process. The search for agents that will directly inhibit intestinal secretory mechanisms and thereby reduce stool volume has been going on for more than 20 years. Research during the past decade has highlighted the importance of neurohumoral mechanisms in the pathogenesis of diarrhoea, notably the role of 5‐hydroxtryptamine, substance P, vasoactive intestinal polypeptide and neural reflexes within the enteric nervous system. Cholera toxin, E. coli enterotoxins and Clostridium difficile toxin A are known to invoke these mechanisms in diarrhoea pathogenesis. This new dimension of intestinal pathophysiology has already exposed possible novel targets for anti‐secretory therapy, namely, 5‐HT receptor antagonists, substance P antagonists and the possibility for potentiating the proabsorptive effects of endogenous enkephalins by use of enkephalinase inhibitors. There now seems to be a real possibility that anti‐secretory therapy will become more widely available in the future.
Enhanced polyadenosine diphosphate‐ribosylation in cirrhotic liver and carcinoma tissues in patients with hepatocellular carcinoma
Authors: Shiobara Masayuki , Miyazaki Masaru , Ito Hiroshi , Togawa Akira , Nakajima Nobuyuki , Nomura Fumio , Morinaga Naoko , Noda Masatoshi
Published: March 2003

Aim: The aim of this study is to assess the poly ADP‐ribosylation activity in human hepatocellular carcinoma (HCC) and in liver cirrhosis (LC) as compared to the activity in normal livers (NL).

Methods: Hepatocellular carcinoma and LC tissues were sampled from 19 patients with HCC. Normal liver tissue was obtained from 19 patients with metastatic liver cancer. Poly ADP‐ribosylation activity of these tissues was measured by using [32P]‐adenylate nicotinamide adenine dinucleotide (NAD)‐incorporation into the 116‐kDa protein. Nicotinamide adenine dinucleotide glycohydrolase activity of these tissues was determined with thin layer chromatography. The immunohistochemical expression of Ki‐67 was also assessed as a parameter of cell proliferative activity.

Results: The poly ADP‐ribosylation of the 116 kDa protein was significantly increased in patients with HCC and LC as compared with NL (P < 0.0001, P < 0.05, respectively) and was inhibited by poly (ADP‐ribose) polymerase inhibitors in a dose‐dependent manner. There was no significant difference in NAD glycohydrolase activity among the three groups. A significant correlation was found between the Ki‐67 positive cell rate and the relative radioactivity of poly ADP‐ribosylation in HCC patients (r = 0.794, P < 0.0001). The poly ADP‐ribosylation of the 116 kDa protein of LC was significantly higher in patients who had recurrences of HCC after hepatic resection than in patients without recurrence (P < 0.05).

Conclusion: Poly ADP‐ribosylation of the 116 kDa protein in HCC patients might be enhanced with its proliferative activity, and poly ADP‐ribosylation of the same protein in LC patients might be a useful parameter of carcinogenic potential for predicting HCC recurrence after hepatectomy in patients who have had HCC.
Dietary fiber fraction of germinated barley foodstuff attenuated mucosal damage and diarrhea, and accelerated the repair of the colonic mucosa in an experimental colitis
Authors: Kanauchi Osamu , Iwanaga Toshihiko , Andoh Akira , Araki Yoshio , Nakamura Tomohiko , Mitsuyama Keiichi , Suzuki Asuka , Hibi Toshifumi , Bamba Tadao
Published: March 2003

Background and Aims: Germinated barley foodstuff (GBF) contains protein and insoluble dietary fiber. We have previously shown in ulcerative colitis patients and a colitis model that GBF feeding attenuates mucosal damage by increasing luminal butyrate levels. However, the detailed mechanism remains unclear because of its heterogeneous nature. The present study was carried out to: (i) evaluate the active ingredient in GBF; and (ii) examine its effect on the repair process in colonic inflammation by using a dextran sulfate sodium (DSS) colitis model.

Methods: Colitis was induced by feeding a diet containing 0.5–3.5% DSS to male Sprague–Dawley rats. (i) Active ingredient: GBF was fractionated enzymatically into fiber‐ and protein‐rich fractions. Each fraction was administered to DSS‐colitis rats. Clinical signs, cecal short chain fatty acid concentrations and serum α1‐acid glycoprotein (AAG) levels were determined. (ii) Effect on mucosal repair: GBF with or without salazosulfapyridine (SASP), or SASP alone was administered to rats after the onset of colitis. Seven days after initial treatment, the number of epithelial cells in HE sections was evaluated morphologically in a blind fashion and serum AAG was determined.

Results: (i) Germinate barley foodstuff and GBF‐fiber significantly attenuated the clinical signs of colitis and decreased serum AAG levels, with a significant increase in cecal butyrate production, while GBF‐protein did not. (ii) Treatment with GBF alone and GBF plus SASP significantly accelerated colonic epithelial repair and improved clinical signs.

Conclusions: These findings suggest that the fiber fraction of GBF may effectively enhance luminal butyrate production, and thereby accelerate colonic epithelial repair in colitis.
Metabolic genotypes and risk for colorectal cancer
Authors: Butler Wendy J , Ryan Philip , Roberts‐Thomson Ian C
Published: March 2003

Background:

Inherited polymorphisms that influence carcinogen metabolism or the composition of bile may influence the risk for the development of colorectal cancer.

Methods:

The frequency of polymorphisms involving N‐acetyltransferase 1 (NAT1), NAT2, cytochrome P450 1A1 (CYP1A1), CYP2D6, CYP2E1, glutathione S‐transferase M1 (GSTM1), GSTT1 and apolipoprotein E were compared in 219 white adults with sporadic colorectal cancer and 200 white controls attending for blood donation at a blood bank. Polymorphisms were determined by using restriction fragment length polymorphism (RFLP) after amplification of genomic DNA by polymerase chain reaction (PCR). Data were analyzed by using standard statistical methods for a case– control study, and reported as odds ratios (OR) with 95% confidence intervals (CI).

Results:

None of the genotypes, either alone or in combination, showed a strong association with colorectal cancer. Inheritance of the GSTT1 null genotype conferred a twofold risk of cancer that was statistically significant with crude data (OR 2.18; 95% CI 1.38–3.43), but not after adjustment for age (OR 1.91; 95% CI 0.99–3.70). There was also a trend towards a lower risk for proximal (right‐sided) cancers in patients with apolipoprotein ɛ4 (OR 0.64; 95% CI 0.31–1.33).

Conclusion:

No strong associations have been found between metabolic genotypes and colorectal cancer risk in Australia. Large studies will be required to confirm weak associations and to establish relationships between cancer risk, metabolic genotypes and exposure to dietary or other environmental carcinogens.
Laterally spreading tumor: Clinicopathological study in comparison with the depressed type of colorectal tumor
Authors: Ohno Yasuhiko , Terai Takeshi , Ogihara Tatsuo , Hirai Shu , Miwa Hiroto
Published: March 2003

Aim: To evaluate the difference between laterally spreading colorectal tumors (LSTs) with depression and depressed‐type colorectal tumors.

Methods: Sixteen LSTs showing the appearance of non‐distinct, gently sloping central depressions were compared clinicopathologically with 14 depressed‐type tumors that were larger than 10 mm in size.

Results: The mean size of LSTs with depression was 13.5 ± 3.4 mm, which was significantly larger than that of the depressed type colorectal tumors (11.2 ± 1.5 mm). The invasion of the depressed‐type colorectal tumors was significantly deeper than that of LSTs with depression, despite the larger size of the LSTs. The surface structures (pit patterns) of both types of tumors were apparently different; the pit patterns of LSTs with depression were almost of the type IIIL pit, while that of the depressed‐type tumors were almost of type V pits (P < 0.01). Histologically, LSTs with depression appeared to grow in a superficial replacing manner on the edge of the lesions, while depressed‐type tumors grew in an expanding manner.

Conclusion: It seems appropriate that these LSTs with depression should be distinguished from depressed‐type colorectal tumors and regarded as constituting a new clinical entity.
Characterization of hepatitis B virus surface antigen‐specific CD4+ T cells in hepatitis B vaccine non‐responders
Authors: Suzuki Tomohiko , Yamauchi Katsumi , Kuwata Tomo , Hayashi Naoaki
Published: March 2003

Aim: To study the mechanisms of hepatitis B vaccine non‐response, we examined hepatitis B virus surface antigen (HBsAg)‐induced proliferation of peripheral blood mononuclear cells (PBMC) obtained from hepatitis B (HB) vaccinees.

Methods: Subsequently, we have examined the features of HBsAg‐reactive CD4+ T cells in HB vaccine non‐responders (NR). Based on serum antibodies to HBsAg (anti‐HBs) titers, we divided these vaccinees into three groups: high responder (HR), middle responder (MR) and non‐responder (NR), and examined HBsAg‐induced proliferation of their PBMC.

Results: We found that the in vitro response of PBMC to stimulation with HBsAg was correlated with their serum anti‐HBs titer (mean stimulation index was 10.71 in HR, 4.37 in MR and 1.96 in NR). However, by the deletion of CD8+ T cells, the increased response was observed in two of four NRs.

Conclusions: The present results have also shown that at least four distinct HBsAg‐reactive CD4+ clones existed (variable gene of T cell receptor β (Vβ) 17 + clone restricted with HLA‐DR locus (DR4), Vβ8 + clone restricted with HLA‐DQ locust (DQ7), and both Vβ5.1 + clone and Vβ20 + clone restricted with either DR9 or DQ3) in NRs. The results demonstrated that heterogeneous HBsAg‐reactive CD4 clones existed in some HB vaccine NRs.
Pharmacokinetics of roxatidine acetate in patients with chronic liver disease
Authors: Tsutsumi Mikihiro , Ueshima Yasuhiro , Takase Shujiro
Published: March 2003

Background and Aim: Patients with liver disease are prone to develop peptic ulceration and often receive H2‐receptor antagonists. Therefore, it is important to clarify whether the pharmacokinetics of H2‐receptor antagonists is affected by hepatic function. However, pharmacokinetics of a new H2‐receptor antagonist, roxatidine acetate, in chronic liver disease has not been well known. In this study, we analyzed the pharmacokinetics of roxatidine in patients with liver disease.

Methods: Blood samples were obtained from 11 patients with chronic hepatitis, 11 patients with cirrhosis and six healthy subjects. Under fasting conditions, 75 mg of roxatidine acetate was administered orally, and plasma roxatidine levels were determined sequentially from 3 to 12 h. Relationships between pharmacokinetic variables and each parameter related to hepatic functions were also investigated.

Results: There was no difference in the pharmacokinetic variables and serum levels of roxatidine between chronic hepatitis and healthy controls. In contrast, in cirrhosis, serum roxatidine levels were significantly higher than those in chronic hepatitis and normal control. Half‐life, the area under the plasma concentration–time curve and clearance in cirrhosis were also significantly longer, bigger and smaller than those in chronic hepatitis and healthy controls, respectively. The half‐life became longer and the clearance became smaller in parallel with the progression of liver disease. Serum levels of hyaluronate and γ‐glutamyl transpeptidase showed a good correlation with half‐life, clearance and elimination rate. A good correlation between creatinine clearance and elimination rate was found.

Conclusion: Pharmacokinetics of roxatidine acetate is affected by hepatic function, and the dosage of roxatidine acetate for patients with liver disease, especially cirrhosis, should be modified.
Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children
Authors: Poddar Ujjal , Thapa Babu R , Bhasin Deepak K , Prasad Arun , Nagi Birendra , Singh Kartar
Published: March 2003

Background and Aim: The role of endoscopic retrograde cholangiopancreatography (ERCP) is not yet fully established in children. The purpose of this study was to assess the use of ERCP in the diagnosis and management of various pancreaticobiliary disorders in children.

Methods: Eighty‐four ERCPs were performed over 5.5 years in 72 children with suspected pancreaticobiliary tract disorders with an adult‐type duodenoscope. In all cases, indications, procedure time, ERCP findings, complications, patients course and therapeutic intervention (if any) were recorded.

Results: The mean (± SD) age of these children was 8.8 ± 3.3 years. Successful cannulation was possible in 70 (97%) cases. Of the 44 cases with suspected biliary tract disease, 14 had a choledochal cyst, 13 had portal biliopathy, two each had CBD stones, primary sclerosing cholangitis and a bile leak, one had biliary ascariasis, eight had a normal cholangiogram, and CBD cannulation failed in two. Eight of the 28 children with suspected pancreatic disorders had chronic pancreatitis, five had pancreatic duct disruption, three had pancreas divisum and the rest had a normal pancreatogram (including all eight children with unexplained abdominal pain). Therapeutic ERCP was performed in 22 children, endoscopic nasobiliary or a nasocystic drain was placed in 16, biliary stenting was conducted in two, pancreatic duct stenting was conducted in three, and minor papilla dilation was conducted in one child. Six children had mild procedure‐related complications.

Conclusion: Endoscopic retrograde cholangiopancreatography is very useful in the treatment of cholangitis, bile leak, pseudocyst and pancreatic fistulae in children. However, its role in unexplained abdominal pain is doubtful.
Intracellular inhibition of the replication of hepatitis B virus by hammerhead ribozymes
Authors: Feng Ying , Kong Yu‐Ying , Wang Yuan , Qi Guo‐Rong
Published: March 2003

Background: Chronic hepatitis B virus (HBV) infection is frequently associated with cirrhosis and hepatocellular carcinoma, and so has become a major worldwide health problem. Hammerhead ribozymes have recently gained some attention as potential tools to inhibit viral infection, for which there are no general effective therapies available.

Methods: A hammerhead ribozyme, RzC, was designed to target the sequence encoding the tail region of the HBV core protein. The activities of the ribozyme were analyzed in vitro and in human hepatoma (HepG2) cells.

Results: In vitro, RzC cleaves HBV‐RNA at its target site up to 30%, while the disabled ribozyme, dRzC, which has a one‐base mutation in the catalytic site, did not cleave the target RNA at all. When the ribozymes were cotransfected into HepG2 cells with the HBV genome‐containing plasmid, p3.6II, the inhibition of HBV replication by RzC was greater than that by dRzC, indicating that the active catalytic domain of the hammerhead ribozyme could increase the extent of antisense‐mediated inhibition. In addition, there was a gradient of effectiveness in which the greater the amount of released ribozyme, the greater the reduction in HBV progeny DNA.

Conclusions: These results suggest the possibility of hammerhead ribozyme‐mediated gene therapy for the treatment of HBV infections.
Portal biliopathy
Authors: Chandra Ramesh , Kapoor Dharmesh , Tharakan Ajith , Chaudhary Adarsh , Sarin Shiv Kumar
Published: March 2003

Abstract In patients with portal hypertension, particularly with extrahepatic portal vein obstruction, portal biliopathy producing biliary ductal and gallbladder wall abnormalities are common. Portal cavernoma formation, choledochal varices and ischemic injury of the bile duct have been implicated as causes of these morphological alterations. While a majority of the patients are asymptomatic, some present with a raised alkaline phosphatase level, abdominal pain, fever and cholangitis. Choledocholithiasis may develop as a complication and manifest as obstructive jaundice with or without cholangitis. Endoscopic sphincterotomy and stone extraction can effectively treat cholangitis when jaundice is associated with common bile duct stone(s). Definitive decompressive shunt surgery is sometimes required when biliary obstruction is recurrent and progressive.
A female with asymptomatic primary biliary cirrhosis associated with pernicious anemia
Authors: Takahashi Toru , Honma Terasu , Ishizuka Kisei , Fuse Ichiro , Asakura Hitoshi
Published: March 2003

We experienced a female case with asymptomatic primary biliary cirrhosis that was associated with pernicious anemia after 16 years from the onset. She was 52 years old when she first visited a clinic in 1981 for liver dysfunction treatment. Antimitochondrial antibody was negative and antipyruvate dehydrogenase complex antibody was positive in a low titer in its immunoglobulin (Ig)M type. Histological examination of her liver revealed a presence of definite chronic non‐suppurative destructive cholangitis with numerous epithelioid cell granuloma. She had been given 600 mg of the oral daily dose of ursodeoxycholic acid since 1992. Macrocytic anemia incidiously appeared in September 1999. An immunological examination detected negative antiparietal cell antibodies and positive anti‐intrinsic factor antibodies. Her bone marrow smear showed numerous megaloblasts and serum vitamin B12 in her blood was low at 99 pg/mL. Severe reversed atrophic‐type gastritis (type A gastritis) was demonstrated by the use of dye‐endoscopy with Congo red. Her macrocytic anemia dramatically improved after intramuscular administration of vitamin B12. In conclusion, attention should be given to the association of pernicious anemia during the follow up of primary biliary cirrhosis.
Benign nodular hepatocellular lesions caused by abnormal hepatic circulation: Etiological analysis and introduction of a new concept1
Authors: Kondo Fukuo
Published: March 2003

AbstractProblems in definitive diagnosis and etiology of various benign nodular hepatocellular lesions were evaluated. Of these lesions, focal nodular hyperplasia (FNH), nodular regenerative hyperplasia (NRH), nodular lesions associated with idiopathic portal hypertension (IPH), non‐cirrhotic large regenerative nodules (LRN), hepatocellular adenoma (HA)‐like hyperplastic nodules, and partial nodular transformation (PNT) have been suggested to be related to abnormal hepatic circulation. However, the following points are considered to need further clarification: (i) is the abnormal circulation caused by thrombosis, vasculitis, or congenital anomaly?; (ii) is thrombosis a cause or a result of congestion?; (iii) are impaired blood vessels primarily the portal veins or arteries?; (iv) how are these disorders related to various syndromes, immunological abnormalities and abnormal blood flow of other organs, which are reported to coexist with these lesions often?; and (v) how should non‐typical cases, which differ from typical cases, be interpreted? In addition, a concept that may lead to solving these problems (anomalous portal tract syndrome; a hypothesis that congenital vascular anomaly is the origin of these benign nodular hepatocellular lesions) was introduced.
Influence of Helicobacter pylori infection and cetraxate on gastric mucosal blood flow during healing of endoscopic mucosal resection‐induced ulcers
Authors: Adachi Kyoichi , Suetsugu Hiroshi , Moriyama Nobuyuki , Kazumori Hideaki , Kawamura Akira , Fujishiro Hirofumi , Sato Hiroshi , Okuyama Toshihiko , Ishihara Shunji , Watanabe Makoto , Kinoshita Yoshikazu
Published: March 2003

Background and Aim:

Helicobacter pylori (H. pylori) infection is known to affect the gastric microcirculation, and cetraxate is reported to accelerate gastric ulcer healing, possibly by augmenting gastric mucosal blood flow (MBF). The aim of this study is to clarify the effect of H. pylori infection and cetraxate on MBF during gastric ulcer healing.

Methods:

Forty‐two patients who had undergone endoscopic mucosal resection (EMR) were studied. Mucosal blood flow was measured by the use of a laser Doppler flowmeter in the surrounding mucosa and at the ulcer margin, before, 1 day, 1 week and 4 weeks after EMR. Helicobacter pylori infection was confirmed by the use of bacterial culture and histology. After EMR, patients were randomly assigned to receive 30 mg lansoprazole (u.i.d; L‐regimen) or 30 mg lansoprazole (u.i.d.) with 200 mg cetraxate (q.i.d; LC‐regimen) for 4 weeks.

Results:

The MBF ratio (MBF at ulcer margin/MBF in surrounding mucosa) 1 week after EMR was significantly lower than that before or 4 weeks after EMR only in H. pylori‐positive patients treated with the L‐regimen. No such decrease in MBF was observed after 1 week in H. pylori‐positive patients treated with the LC‐regimen or in H. pylori‐negative patients.

Conclusion:

A transient decrease in MBF was detected at the ulcer margin during healing of EMR‐induced ulcers in H. pylori‐infected patients. Cetraxate seemed to prevent this decrease in MBF.
Antimitochondrial autoantibodies in saliva and sera from patients with primary biliary cirrhosis
Authors: Ikuno Nobuhiro , Mackay Ian R , Jois Jennifer , Omagari Katsuhisa , Rowley Merrill J
Published: March 2003

Background and Aims: Primary biliary cirrhosis (PBC) is a cholestatic autoimmune liver disease characterized by antimitochondrial autoantibodies (AMA) in serum, for which the reactants are E2 subunits of the three 2‐oxoacid dehydrogenase (2‐OAD) enzymes, particularly pyruvate dehydrogenase complex (PDC‐E2). Some 70% of patients with PBC have a coexisting autoimmune disease including Sjögren's syndrome. We aimed to ascertain the frequency and isotype of AMA in saliva in PBC.

Methods: Serum and saliva from 12 patients with PBC were tested for AMA by immunoblotting on bovine heart mitochondria, and by an automated microassay based on inhibition of the enzymatic activity of PDC.

Results: Autoantibodies of the immunoglobulin (Ig)G, IgM, and IgA immunoglobulin isotypes against the E2 subunits of 2‐OAD enzymes were demonstrable in PBC in serum (12 of 12 cases) and saliva (nine of 12 cases). Salivary autoantibodies, like serum autoantibodies, were predominantly reactive with PDC and of the IgG isotype. Results for serum and saliva corresponded closely with regard to reactivity with individual enzymes of the 2‐OAD enzyme family, and to the autoantibody isotype that was predominantly expressed, and also in the capacity to inhibit the enzymatic activity of PDC.

Conclusions: The presence of AMA in saliva to 2‐OAD enzymes indicates that salivary glands could participate in the pathogenetic process of PBC. The detection of salivary AMA by a semi‐automated enzyme inhibition assay offers possibilities for rapid population screening for detection of preclinical PBC among at‐risk individuals, middle‐aged to older women.
Brachyspira aalborgi infection in four Australian children
Authors: Heine Ralf G , Ward Peter B , Mikosza Andrew Sj , Bennett‐Wood Vicki , Robins‐Browne Roy M , Hampson David J
Published: March 2003

Aim: The clinical presentation of four children and adolescents (two males and two females with a mean age of 12.4 years; range 9–16 years) with colorectal spirochetosis is discussed.

Results: Symptoms included persistent diarrhea (n = 2), rectal bleeding (n = 1) and abdominal pain (n = 2). In all patients, colorectal spirochetosis was an unanticipated finding on colonic histology, and the presence of spirochetes was confirmed by the use of electron microscopy. Spirochetes were identified as Brachyspira aalborgi by using PCR amplification of the bacterial 16S rRNA and nicotinamide adenine dinucleotide oxidase sequences in all four patients. No other enteric pathogens were found.

Conclusions: Although all patients appeared to respond to antibiotic treatment, the clinical significance of B. aalborgi as a human pathogen requires further investigation.
Evaluation of a new formulation CLOtest
Authors: VIIALA CHARLIE H , WINDSOR HELEN M , FORBES GEOFF M , CHAIRMAN SIMON O , MARSHALL BARRY J , MOLLISON LINDSAY C
Published: March 2003

Background and Aims The CLOtest® and other rapid urease detection kits are widely used in the endoscopic diagnosis of Helicobacter pylori. A new formulation CLOtest has been developed with the goal of obtaining a positive result more rapidly. The aims of this study were to validate the sensitivity and specificity of the new test and compare the time taken for a positive result to be visible in both the new and standard CLOtest.

Methods Patients presenting for endoscopy at three Western Australian hospitals were prospectively enrolled. Gastric mucosal biopsies were obtained for the standard and new CLOtest and for histology. Grading of color change was conducted by staff blinded to the type of CLOtest used and conducted according to a standardized color chart. Helicobacter pylori status was defined by the combination of a positive standard CLOtest and histology, against which the new CLOtest was compared. Results were obtained at 1, 3 and 24 h, and at one center, at 10 min intervals for the first hour.

Results Three hundred and thirty‐five patients were enrolled. Eighty‐eight Helicobacter pylori‐positive individuals were identified. At 24 h, the new test correctly identified all 88, with one false‐positive result (sensitivity 100%, specificity 99.6%). At 1 h, sensitivity was 93% with a number of early false‐positive results reducing specificity to 96%. Compared to the current CLOtest, the new formulation became positive faster at 20 min (P = 0.001, n = 51), but was similar at 1 h (P = 0.06, n = 88) and equivalent at 3 h.

Conclusions The new formulation CLOtest is sensitive and specific, with a trend to give early positive results more quickly, although accuracy at 3 and 24 h is the same.
Microscopic colitis
Authors: TAGKALIDIS PETER , BHATHAL PRITHI , GIBSON PETER
Published: March 2003

Abstract Microscopic colitis is an umbrella term used to include two idiopathic inflammatory bowel disorders that present with chronic watery diarrhea, normal endoscopic findings and characteristic inflammatory changes on histology. Collagenous colitis and lymphocytic colitis are distinguished by the presence of a thickened subepithelial collagen table. It is likely that they are a spectrum of one disease, but this is yet to be proven. The majority of cases tend to undergo spontaneous remission within a few years of onset, and their clinical course is benign, with no increase in risk of colorectal cancer. Sufficient evidence exists to suggest that microscopic colitis occurs as a response to one or more luminal antigens. A variety of medications have been reported in the treatment of this condition, but only colloidal bismuth and budesonide have thus far been shown to be effective in randomized controlled trials.

© 1902 Blackwell Science Asia Pty Ltd
Effects of splenectomy on liver volume and prognosis of cirrhosis in patients with esophageal varices1
Authors: Tomikawa Morimasa , HASHIZUME MAKOTO , AKAHOSHI TOMOHIKO , SHIMABUKURO RINSHUN , GOTOH NORIKAZU , OHTA MASAYUKI , SUGIMACHI KEIZO
Published: March 2003

Background: Several previous studies have shown that hepatic regeneration after partial hepatic resection accelerates over time once a splenectomy has been performed. This was a retrospective study investigating whether a splenectomy has some beneficial effects for cirrhotic patients with esophageal varices.

Methods: Ninety‐three patients underwent either esophageal transection, including splenectomy (splenectomy group), or endoscopic injection sclerotherapy (controls) for esophageal varices. No patient had hepatocellular carcinoma and the grades of their hepatic function were from mild to moderate. The changes in hepatic and splenic functions and liver volume were evaluated, as well as the probability of survival.

Results and Conclusions: Both plasma white blood cell and platelet counts significantly increased in the

splenectomy group compared to the controls (P < 0.05). The proportion of liver volume 1 year after the treatments compared to the volume before the treatments (which was 100%) was 96.4% in splenectomy group and 94.4% in controls. No patient had serious complications, such as severe infection caused by the splenectomy. The two groups showed no statistically significant differences in survival rates throughout this study. Although hypersplenism significantly was improved by splenectomy, no difference in changes in liver volume nor survival probability between the two groups was found. Further studies, such as those with a large number of patients, long‐term volumetric analysis, or histopathological examination, are needed to clarify fully the effects of splenectomy on cirrhotic patients.