bluuebunny/crossref_metadata_2025 huggingface dataset:
Life‐threatening haemorrhage from a sternal metastatic hepatocellular carcinoma
Authors: Chen Chih‐Yen , Chau Gar‐Yang , Yen Sang‐Hue , Hsieh Yu‐Hsi , Chao Yee , Chi Kwan‐Hwa , Li Chung‐Pin , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Rupture of the tumour is a catastrophic complication of hepatocellular carcinoma. The prognosis in patients with a ruptured hepatocellular carcinoma is usually unfavourable. We describe a 46‐year‐old man who suffered from visible massive tumour haemorrhage due to a hepatitis B‐related hepatocellular carcinoma that metastasized to the sternal bone. The prominent tumour mass was bulging over the anterior chest wall on the sternum of the patient, and bled spontaneously. This episode of life‐threatening haemorrhage was stopped by surgical ligation of the bleeding site. Palliative radiotherapy shrank the tumour mass size and prevented further possible bleeding. This is likely to be the first reported case with a visible spontaneous tumour bleeding from a sternal metastatic hepatocellular carcinoma.
Serotyping and genotyping of hepatitis C virus in Taiwanese patients with type C chronic liver disease and uraemic patients on maintenance haemodialysis
Authors: Yu Ming‐Lung , Wang Liang‐Yen , Chuang Wan‐Long , Dai Chia‐Yen , Sung Ming‐Hsing , Chen Shinn‐Cherng , Lin Zu‐Yau , Hsieh Ming‐Yuh , Tsai Jung‐Fa , Chang Wen‐Yu
Published: March 2003

Background
: To evaluate a recombinant immunoblot hepatitis C virus (HCV) serotyping assay, which determines HCV serotypes 1, 2, and 3 by detecting type‐specific antibodies to core‐and NS‐4‐derived peptides.

Methods
: Immunoreactivity of type‐specific antibodies among 173 chronic hepatitis C patients and 43 haemodialysis patients in Taiwan was examined and the serotyping results were compared with genotyping by Okamoto’s method. Serial specimens from 29 patients undergoing interferon‐α therapy were also evaluated.

Results
: Of the 205 specimens for which genotyping data were available, 51.2% were of serotype 1, 31.7% of serotype 2, 1.0% of serotype 3, 2.4% of either serotype 1 or 3, and the remaining 13.7% were untypable. The serotypable rate was significantly lower in haemodialysis patients than in chronic hepatitis C patients (70.0%vs 94.9%; P < 0.001). Serotyping of genotype 2b specimens was significantly more dependent on core peptide bands than other genotypes. Using genotyping as the reference, the overall sensitivity, specificity and concordance of the recombinant immunoblot HCV serotyping assay were 86.3%, 97.2% and 83.9%, respectively. However, the serotyping assay had significantly lower sensitivity (69.2%), specificity (77.8%) and concordance (53.8%) for genotype 2b specimens. Of nine HCV complete responders, one lost type‐specific antibodies 6 months after the cessation of interferon‐α treatment.

Conclusions
: These results suggest that, except for less than optimal performance with immunocompromised or genotype 2b patients, the HCV serotyping assay is a practical and useful method for HCV typing in the clinical setting in Taiwan.
Hepatitis G virus genotypes in Australia, Papua New Guinea and the Solomon Islands: A possible new Pacific type identified
Authors: Mison Lm , Hyland Ca , Poidinger M , Borthwick Ia , Faoagali J , Aeno U , Gowans Ej
Published: March 2003

Background
: Hepatitis G Virus (HGV)/GB Virus‐C (GBV‐C) is a newly discovered RNA virus. Nucleotide sequence comparison and phylogenetic studies of the 5′ untranslated region (5′UTR) within the viral genome have identified at least three different types which have provisionally been classified as type 1 (West African origin), type 2 (North American origin) and type 3 (Asian origin).

Methods and Results
: The products of RT‐PCR were sequenced by using blood donors and patients infected with HGV/GBV‐C in Australia, Papua New Guinea and the Solomon Islands to investigate the genotype distribution in this area of the world. All the Australian isolates showed strong sequence homology with type 2, while the Papua New Guinea and Solomon Islands sequences were more closely related, but differ from type 3, which has previously been reported from isolates studied within Asia.

Conclusions
: Phylogenetic analysis suggests that these latter sequences are either a new HGV/GBV‐C Pacific type or a subtype of the Asian type RNA virus. Isolates homologous with type 1 were not identified in these population groups.
Are there any sex differences in fatty liver? A study of glucose metabolism and body fat distribution
Authors: Lonardo A , Trande P
Published: March 2003

Background and Aims
: Fatty liver is a common condition found more often in males. Whether sex differences affect its development is presently unknown. The hypothesis that glucose metabolism alterations or central body fat distribution are gender‐related in fatty liver was investigated.

Methods
: Overall 199 consecutive subjects seen in the Division of Internal Medicine and Gastroenterology, Modena City Hospital, were enrolled. In the main arm of the present study, 44 men with sonographic fatty liver and 47 controls without, and 18 women with and 19 without fatty liver had their body mass index (an index of overall adiposity), hepatobiliary serum enzymes, serum cholesterol and triglycerides determined. All underwent oral glucose tolerance tests (estimated through the glucose area under the curve with the trapezoidal method). In the ancillary arm study, 17 other men with and 14 without, and 11 other women with and 29 without fatty liver had anthropometric measurements of body fat distribution (waist/hip, waist/height and skinfold thickness).

Results
: Following statistical evaluation including univariate and multivariate analyses (main study), elevated body mass index was found to be an independent predictor of fatty liver in either sex. Glucose area under the curve and a central‐type body fat distribution (ancillary study) predicted FL only in women.

Conclusions
: Fatty liver could be gender‐related in the present series.
Acinar cell carcinoma with hypervascularity
Authors: Chen Jin‐De , Wu Ming‐Shiang , Tien Yu‐Wen , Kuo Kuang‐Ting , Chang Ming‐Chu , Lin Jaw‐Town
Published: March 2003

Abstract Acinar cell carcinoma is an uncommon malignancy with a reported incidence of 1% among exocrine tumors of the pancreas. The case of a 60‐year‐old Taiwanese man who presented with obstructive jaundice, abdominal pain, and body weight loss is described here. A mixed clinical picture of islet cell tumor and ductal carcinoma of the pancreas was shown to be a hypervascular tumor at the pancreatic head region with an irregular stricture at the common channel of the common bile and pancreatic ducts. The patient had normal levels of plasma carcinoembryonic antigen, carbohydrate antigen 19–9, α‐fetoprotein, but an increase in plasma levels of insulin and C‐peptide. Immunohistochemical stains and electron microscopic examination of the tumor was consistent with acinar cell carcinoma.
Comparison of clinical, serological and histological findings between non‐ulcer dyspepsia patients with and without Helicobacter pylori infection
Authors: Lo Ching‐Chu , Hsu Ping‐I , Lo Gin‐Ho , Lai Kwok‐Hung , Cheng Jin‐Shiung , Tseng Huei‐Hwa , Lin Chiun‐Ku , Chan Hoi‐Hung , Wang Ya‐Yu , Ku Ming‐Kun , Lin Chi‐Pin , Peng Nan‐Jing , Chien Eileen Jea
Published: March 2003

Background and Aims: The role of Helicobacter pylori (H. pylori) infection in non‐ulcer dyspepsia (NUD) remains controversial. This study investigates the clinical, serological and histological differences between patients with H. pylori‐positive and ‐negative NUD.

Methods: One hundred and eighty consecutive patients with NUD were enrolled from January to December 1998. The severity of symptoms was evaluated by the Tucci's scoring system. The histological changes of gastric mucosa were assessed according to the Updated Sydney System, and a fasting blood sample was obtained to test the serum gastrin and pepsinogen I levels.

Results: The H. pylori‐positive NUD patients were notably older than H. pylori‐negative NUD patients (48.2 ± 15.9 vs 39.8 ± 15.7 years, P = 0.001). There were no differences in other clinical factors between the two NUD groups. The serum pepsinogen I levels were considerably higher in H. pylori‐positive NUD patients than in H. pylori‐negative NUD patients (78.9 ± 42.2 vs 61.5 ± 43.3 ng/mL, P < 0.01). However, no significant differences in serum gastrin levels were discovered between the two groups. The antrum histological scores for chronic inflammation, acute inflammation, gland atrophy and lymphoid follicles were higher in H. pylori‐positive NUD patients than in H. pylori‐negative NUD patients (2.09 vs 1.01, P < 0.001; 1.22 vs 0.36, P < 0.001; 0.76 vs 0.36, P < 0.01; 0.33 vs 0.13, P < 0.01, respectively).

Conclusions: The present study discovered marked differences in age, serum pepsinogen I levels, histological grades of acute inflammation, chronic inflammation, gland atrophy and lymphoid tissue formation between H. pylori‐positive and H. pylori‐negative NUD patients. Further investigation of the clinical prognosis of the two groups of patients is necessary.
Advanced gastric cancer with multiple lymph node metastasis successfully treated with etoposide, adriamycin and cisplatin
Authors: Shigemitsu Kaori , Naomoto Yoshio , Matsuno Tsuyoshi , Gochi Akira , Isozaki Hiroshi , Tanaka Noriaki
Published: March 2003

Abstract Gastric cancer usually shows poor sensitivity to chemotherapy, and the presence of lymph node metastases is associated with extremely poor prognosis, especially when the number of such nodes is more than 10. We report here a case of advanced gastric cancer with histopathologically confirmed metastases in 15 regional lymph nodes, in which the recurrent tumor was sensitive to combination chemotherapy. Distal gastrectomy with lymphadenectomy was performed for the primary tumor. A hard (recurrent) tumor was detected in the upper abdomen 5 months postoperatively. Abdominal CT revealed two tumors measuring 3.5 × 1.8 and 3.3 × 2 cm in diameter at the front of the pancreatic head, which suggested recurrence. Etoposide, adriamycin and cisplatin (EAP) chemotherapy (20 mg/kg adriamycin, 100 mg/kg etoposide and 50 mg/kg cisplatin (CDDP)) was administered every 6 weeks. The tumors regressed and became undetectable on CT after four cycles. At that stage, CDDP was replaced with 400 mg/kg carboplatin, which was administered every 1 or 2 months. The patient had no recurrence 8 years after surgery. For treatment of advanced gastric cancer with multiple lymph node metastases, a wide resection of the tumor should be performed followed by treatment of the residual tumor cells with a suitable combination chemotherapy taking into consideration the characteristics of the tumor and the condition of the host. We present a patient with gastric cancer and histopathologically confirmed metastases in 15 regional lymph nodes, who was successfully treated by surgery followed by EAP adjuvant chemotherapy. The patient remains alive and well at 8 years after surgery.
Differences in the efficacy of ursodeoxycholic acid and bile acid metabolism between viral liver diseases and primary biliary cirrhosis
Authors: Nakashima Toshiaki , Yoh Takaharu , Sumida Yoshio , Kakisaka Yuko , Mitsuyoshi Hironori
Published: March 2003

Aim and Methods: The effects of ursodeoxycholic acid (UDCA, 600 mg/day) on liver function test values, and serum and urinary bile acids levels in hepatitis C virus‐related chronic hepatitis (CH, n = 39) and liver cirrhosis (LC, n = 25), and in primary biliary cirrhosis (PBC, n = 25) were compared.

Results: The percentages of improvement in alanine transaminase (ALT) and gamma‐glutamyl transpeptidase (γ‐GTP) in CH were almost the same in LC. The rates of improvement in ALT in PBC were negatively correlated with histological stages in the liver. Total serum bile acid levels in LC rose to the same extent as in CH, but the increases in PBC were significantly smaller at stages 3–4 than stages 1–2. The urinary levels of hydroxylated metabolites of UDCA only slightly increased in LC, but they increased significantly at PBC stages 3–4.

Conclusions: The efficacy of UDCA was preserved in LC, but diminished at PBC stages 3–4. The poor enrichment of UDCA in the bile acid pool and extensive biotransformation of UDCA may cause the limited efficacy of UDCA in the cirrhotic stage of PBC.
Gastrointestinal transit and anorectal manometry in children with colonic substance P deficiency
Authors: Treepongkaruna Suporn , Hutson John M , Hughes Jodie , Cook David , Catto‐Smith Anthony G , Chow Chung Wo , Oliver Mark R
Published: March 2003

Background and Aims:

Severe intractable constipation in children may be associated with a reduction of substance P (SP)‐ containing fibers in colonic circular muscle. The aim of this study was to characterize gastrointestinal transit (GIT), anorectal manometry (ARM) and electromyographic (EMG) changes in these children.

Methods:

Seromuscular laparoscopic biopsies of the colon were obtained from 35 children with severe constipation. Immunofluorescent staining for SP and vasoactive intestinal peptide (VIP) were then performed on these specimens. The cohort of patients studied included a SP‐deficient group (SPD, n = 25) who had reduced numbers of SP‐immunoreactive nerve fibers. The other group consisted of patients with normal staining for both SP and VIP (SPN, n = 10). Gastrointestinal transit studies (gastric emptying, orocecal and colonic transit) suitable for analysis were available for 17 patients (SPD, n = 9 and SPN, n = 8). The colon was divided into segments and radioactivity counts in each segment were expressed as a percentage of the total colonic count at each time point (6, 24, 32 and 48 h). The geometric center (GC), ARM, EMG, clinical and demographic data characteristics of both groups of patients were compared.

Results:

There were no differences in demographic data, gastric emptying, orocecal transit or geometric center of transit in the colon between the two patient groups. The ARM and EMG studies suggested that the SPN group have a higher mean threshold volume of balloon distension required to initiate a rectoanal inhibitory reflex, and a higher incidence of anismus; however, this did not reach statistical significance.

Conclusions:

These data suggest a trend that the SPN patients have a greater problem with obstructive defecation and abnormal rectal sensation than those with SPD. We were unable to confirm any defect in colonic transit in the SPD patients compared with the SPN group.
Effect of interferon therapy on Japanese chronic hepatitis C virus patients with anti‐liver/kidney microsome autoantibody type 1
Authors: Iijima Yoshihiko , Kato Takanobu , Miyakawa Hiroshi , Ogino Masataka , Mizuno Makoto , Sugihara Kanji , Ando Takahiro , Fujiwara Kei , Orito Etsuro , Ueda Ryuzo , Mizokami Masashi
Published: March 2003

Aim: The aim of this study was to determine the prevalence of anti‐liver/kidney microsome autoantibody type 1 (anti‐LKM‐1) among hepatitis C virus (HCV)‐infected Japanese patients at various stages (chronic hepatitis, liver cirrhosis and hepatocellular carcinoma), and to assess the influence of anti‐LKM‐1 on interferon therapy.

Methods: A total of 390 serum samples from 215 HCV‐infected patients with chronic hepatitis (HCV‐CH), 81 HCV‐infected patients with liver cirrhosis (HCV‐LC), and 94 HCV‐HCC infected patients were subjected to examination. Ninety‐one HBsAg‐positive patients and 137 healthy subjects served as controls. Anti‐liver/kidney microsome autoantibody type 1 was determined by using a newly developed ELISA using recombinant cytochrome P450 IID6 as the antigen.

Results: Anti‐liver/kidney microsome autoantibody type 1 was detected in six of the 390 (1.5%) chronic HCV‐infected patients (four were HCV‐CH and two were HCV‐LC); in contrast, it was not detected in control groups. Among the 110 HCV‐CH patients treated with interferon (IFN), four were positive for anti‐LKM‐1. No change in anti‐LKM‐1 immunoreactivity from negative to positive during interferon therapy was observed. Moreover, no increase in the serum alanine aminotransferase level was observed in these four patients with anti‐LKM‐1.

Conclusion: Our study indicates that: (i) anti‐LKM‐1 does not aggravate the liver disease associated with HCV infection; and (ii) no change in anti‐LKM‐1 immunoreactivity from negative to positive or no aggravations of liver dysfunction were observed among HCV‐CH patients during the IFN therapy for Japanese patients with liver disease.
Clinicopathological features of gastric mucosa‐associated lymphoid tissue lymphoma: A comparison with diffuse large B‐cell lymphoma without a mucosa‐associated lymphoid tissue lymphoma component
Authors: Hiyama Toru , Haruma Ken , Kitadai Yasuhiko , Masuda Hiroshi , Miyamoto Masaki , Ito Masanori , Kamada Tomoari , Tanaka Shinji , Uemura Naomi , Yoshihara Masaharu , Sumii Koji , Shimamoto Fumio , Chayama Kazuaki
Published: March 2003

Background and Aims: The aim of this study was to clinicopathologically distinguish the pathogenesis of gastric mucosa‐associated lymphoid tissue (MALT) lymphoma and diffuse large B‐cell lymphoma without a MALT lymphoma component (DLL).

Methods: We investigated clinicopathological features of these gastric lymphomas including age, sex ratio, tumor location and depth, macroscopic appearance, and infection with Helicobacter pylori of these gastric lymphomas and hepatitis viruses in 24 patients with gastric low‐grade MALT lymphoma, 10 patients with high‐grade MALT lymphoma, and 19 patients with DLL. The frequency of H. pylori infection in lymphoma patients was compared with that in age‐ and sex‐matched control subjects.

Results: There was a predominance of females with MALT lymphoma (male to female ratio, 8/16 for low‐grade MALT lymphomas and 1/9 for high‐grade MALT lymphomas), and there was a predominance of males with DLL (male to female ratio, 13/6); the ratios differed significantly (P < 0.05). Ninety‐two percent of low‐grade MALT lymphomas and 80% of high‐grade MALT lymphomas were confined to the mucosal and submucosal layers, but lymphoma cells invaded the muscular layer or more deeply in 74% of DLL. Helicobacter pylori infection occurred significantly more often in patients with low‐grade MALT lymphoma than in age‐ and sex‐matched controls (96 vs 67%, P < 0.01). Conversely, the frequency of H. pylori infection in DLL patients did not differ from that in controls.

Conclusions: These data suggest that H. pylori infection may be associated with the development of gastric MALT lymphoma, but not DLL, and that MALT lymphoma and DLL may have a different pathogenesis.
Perioperative changes in carbonylhemoglobin and methemoglobin during abdominal surgery: Alteration in endogenous generation of carbon monoxide
Authors: TAKEDA RYOJI , TANAKA AKIRA , MAEDA TOSHIKI , YAMAOKA YOSHIO , NAKAMURA KUMI , SANO KAORU , KATAOKA MASATO , NAKAMURA YOSHIAKI , MORIMOTO TAISUKE , MUKAIHARA SUMIO
Published: March 2003

Abstract
Background:
Carbon monoxide (CO), which is homologous to nitric oxide (NO) as a monoxide, has been recently studied as a novel gaseous mediator for the maintenance of circulatory homeostasis and as a regulator of organ functions. Abdominal surgery is supposed to modulate the gaseous mediator by the reduction of heme oxygenase (HO) activity or transcriptional regulation of inducible HO. Therefore, we investigated perioperative changes in CO generation during abdominal surgery.

Methods:
A total of 397 patients who received abdominal surgery under intubation anesthesia were studied retrospectively by spectrophotometric analysis of carbonylhemoglobin (COHb) and methemoglobin (metHb) in arterial blood obtained at three points: before operation; several hours after return from operation room (0 POD); and next morning (1 POD). Thirty‐three splenectomies, 36 hepatectomies and 42 drainages with control of infection focus for peritonitis were compared with 286 controls. The influences of smoking and blood transfusion were disregarded in the analysis, because smoking and blood transfusion were shown to increase exogenous and endogenous CO, respectively.

Results:
In the non‐smoker control group without blood transfusion, COHb did not change during the perioperative period, while metHb increased from the preoperative value of 0.52 ± 0.03 to 0.72 ± 0.02 at 0 POD and returned to 0.45 ± 0.03 mg/dL at 1 POD. In the splenectomy group, COHb decreased from the preoperative value of 1.63 ± 0.36 to 1.19 ± 0.20 and 1.13 ± 0.26 mg/dL at 0 and 1 POD, respectively, as a result of the removal of the organ with high HO activity. In the splenectomy group MetHb remained low: 0.47 ± 0.09 mg/dL at 0 POD as compared with the control value. In the peritonitis and hepatectomy groups, COHb did not change during the perioperative period, while metHb increased to 0.64 ± 0.06 and 0.73 ± 0.10 mg/dL at 1 POD, respectively, as compared with the control value. In the hepatectomy group with or without blood transfusion, however, COHb and metHb were higher at 1 POD than the corresponding control value.

Conclusion:
Changes in COHb and metHb concentrations in arterial blood occur during abdominal surgery, although these amplitudes are small when compared with CO intoxication and methemoglobulinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during abdominal surgery.

© 2002 Blackwell Publishing Asia Pty Ltd
Decreased production of insulin‐like growth factor‐binding protein (IGFBP)‐6 by transfection of colon cancer cells with an antisense IGFBP‐6 cDNA construct leads to stimulation of cell proliferation
Authors: KIM EUN J , SCHAFFER BEVERLY S , KANG YOUNG‐HEE , MACDONALD RICHARD G , PARK JUNG HY
Published: March 2003

Abstract

Background
: Previously, we have observed that highly unsaturated dietary (n‐3) fatty acids inhibit cell proliferation in conjunction with stimulation of insulin‐like growth factor‐binding protein (IGFBP)‐6 secretion in Caco‐2 cells, a human colon carcinoma cell line.

Methods
: To test the converse hypothesis that inhibition of endogenous IGFBP‐6 secretion stimulates Caco‐2 cell proliferation, cells were transfected with the antisense IGFBP‐6 expression construct or pcDNA3 vector only, and single colonies resistant to G418 sulfate were isolated.

Results
: Our initial studies indicated that three antisense clones grew faster and produced less IGFBP‐6 than two pcDNA3 clones, so antisense IGFBP‐6 #5 and pcDNA3 #8 were selected for further detailed analysis. Both the control and antisense clones grew in serum‐free medium reaching a plateau density at day eight. However, the antisense clone grew at a rate faster than that of the control and reached a final density that was 31 ± 3% higher than the control. Northern blot, ligand blot and immunoblot analyses revealed that accumulation of IGFBP‐6 mRNA and concentrations of IGFBP‐6 peptide produced by the antisense clone were decreased by 80–90% compared to the control. The doubling times of the antisense and control clones were 21.9 ± 0.4 and 24.8 ± 0.3 h (P < 0.05), respectively. Exogenous IGF‐I and IGF‐II (0.2–200 nmol/L) stimulated proliferation of both the control and antisense clones in a dose‐dependent manner, but the relative potency and efficacy of IGF‐II was higher in the antisense clone compared to the control. These results indicate that suppression of IGFBP‐6 secretion correlates with an increase in the basal rate of Caco‐2 cell growth.

Conclusions
: Our findings are consistent with the hypothesis that IGFBP‐6 inhibits cell growth by binding to endogenously produced IGF‐II, thereby preventing IGF‐II from interacting with the IGF‐I receptor to stimulate cellular proliferation by an autocrine mechanism.

© 2002 Blackwell Publishing Asia Pty Ltd
Reciprocal relationship between methylation status and loss of heterozygosity at the p14ARF locus in Australian and South African hepatocellular carcinomas
Authors: HERATH NIRMITHA I , KEW MICHAEL C , WALSH MICHAEL D , YOUNG JOANNE , POWELL LAWRIE W , LEGGETT BARBARA A , MACDONALD GRAEME A
Published: March 2003

Abstract Chromosome 9p21, a locus comprising the tumor suppressor genes (TSG) p16INK4a
and p14ARF, is a common region of loss of heterozygosity (LOH)
in hepatocellular carcinoma (HCC). p14ARF shares exon 2 with p16
in a different reading frame. p14 binds to MDM2 resulting in a stabilization of functional
p53. This study examined the roles of p14, p16 and p53 in hepatocarcinogenesis,
in 37 Australian and 24 South African patients. LOH at 9p21 and 17p13.1, p14
and p16 mutation analysis, p14 and p16 promoter methylation
and p14, p16 and p53 protein expression was examined. LOH at 9p21 was detected more
frequently in South African HCC (P = 0.04). Comparable rates of p53
LOH were observed in Australian and South African HCC (10/22, 45%vs
13/22, 59%, respectively). Hypermethylation of the p14 promoter was
more prevalent in Australian HCC than in South African HCC (17/37, 46%vs
7/24, 29%, respectively). In Australian HCC the prevalence of p14
methylation increased with age (P = 0.03). p16 promoter methylation
was observed in 12/37 (32%) and 6/24 (25%) in Australian and South
African HCC, respectively. Loss of p16 protein expression was detected in 14/36 Australian
HCC whereas p53 protein expression was detected in 9/36. Significantly, a reciprocal
relationship between 9p21 LOH and p14 promoter hypermethylation was observed
(P≤0.05). No significant association between p14 and p53 was seen in this study. The reciprocal relationship identified indicates different pathways of tumorigenesis and likely reflects different etiologies of HCC in the two countries.

© 2002 Blackwell Science Asia Pty Ltd
Update on the management of Helicobacter pylori infection, including drug‐resistant organisms
Authors: Goh KL
Published: March 2003

Abstract  Helicobacter pylori infection has many different clinical outcomes. Not all infected persons need to be treated. Therefore, indications for treatment have to be clear, and several consensus guidelines have been formulated to aid the medical practitioner in this decision‐making process. Triple therapy with a proton pump inhibitor (PPI), in combination with amoxicillin and clarithromycin is the established treatment of choice. For patients with penicillin hypersensitivity, metronidazole can be substituted for amoxicillin. Bacterial resistance to antibiotics is a major factor adversely affecting treatment success. Resistance to metronidazole has been reported in up to 80%, and resistance to clarithromycin in 2–10% of strains cultured. Resistance to either one of the antibiotics has been reported to result in a drop in efficacy of up to 50%. Emergence of resistance to both metronidazole and clarithromycin following failed therapy is a cause for concern; this underlines the need to use the best available first‐line therapy. To avoid the emergence of resistance to both key antibiotics, the combination of metronidazole and clarithromycin should be avoided where possible. For failed treatment, several strategies can be employed. These include ensuring better compliance with repeat therapy, and maximizing the efficacy of repeat treatment by increasing dosage and duration of treatment, as well as altering the choice of drugs. Quadruple therapy incorporating a bismuth compound with a PPI, tetracycline and metronidazole has been a popular choice as a ‘rescue’ therapy. Ranitidine bismuth citrate has been shown to be able to overcome metronidazole and clarithromycin resistance; it may be a useful compound drug to use in place of a PPI in ‘rescue’ therapies. In the case of persistent treatment failures, it is useful to consider repeating gastroscopy and obtaining tissue for culture, and then prescribe antibiotics according to bacterial susceptibility patterns. It is also important in refractory cases to review the original indication for treatment and determine the importance of the indication.

© 2002 Blackwell Publishing Asia Pty Ltd
Randomized comparative study of omeprazole and famotidine in reflux esophagitis
Authors: Kawano Sunao , Murata Hiroaki , Tsuji Shingo , Kubo Mitsuhiko , Tatsuta Masaharu , Iishi Hiroyasu , Kanda Tsutomu , Sato Tomonobu , Yoshihara Harumasa , Masuda Eiji , Noguchi Masahiko , Kashio Shinji , Ikeda Masahiro , Kaneko Akira
Published: March 2003

Background: Although proton pump inhibitors (PPI) and H2‐receptor antagonists (H2‐RA) are routinely used in the treatment of reflux esophagitis (RE), no consensus has been reached yet as to whether the first‐choice drug should be PPI or H2‐RA. In this study, the effects of omeprazole (OMP) and famotidine (FAM) on RE have been examined in a randomized comparative study.

Methods: Protocols of OMP 20 mg once daily or FAM 20 mg twice daily for 8 weeks were allocated to 56 cases with RE at random, using an envelope randomization method. Their efficacy in achieving healing was examined endoscopically and a relief from subjective symptoms was compared.

Results: Patient's background such as sex, age, recurrence, hiatal hernia, smoking and drinking habits, and complications, and the severity of esophagitis at the time of enrolment were not significantly different between the two groups. Healing in the OMP group and the FAM group was observed in 72 and 32% (P = 0.025) of patients at week 4 and 95 and 53% (P = 0.003) of patients at week 8, respectively. Subjective symptoms were relieved more frequently in the OMP group (at week 2, 67% compared with 29%, P = 0.005; at week 4, 95% compared with 55%, P = 0.009), but this superiority was not significant at week 8 (94% compared with 65%, P = 0.085). No serious adverse events occurred.

Conclusions: Omeprazole provided quicker healing and a greater relief from subjective symptoms than did FAM in the treatment of RE, and was considered more suitable as a first‐choice drug.

© 2002 Blackwell Publishing Asia Pty Ltd
Efficacy of granulocyte‐macrophage colony‐stimulating factor or lamivudine combination with recombinant interferon in non‐responders to interferon in hepatitis B virus‐related chronic liver disease patients
Authors: GUPTAN RAJKUMAR C , THAKUR VARSHA , KAZIM SEYED N , SARIN SHIV K
Published: March 2003

Abstract
Background and Aims
: Non‐response to interferon (IFN) monotherapy is a major therapeutic problem in the management of chronic hepatitis B infection. The efficacy of combination therapy to enhance the immunomodulatory effect of IFN by combining granulocyte‐macrophage colony‐stimulating factor (GMCSF) or decreasing viral load by adding an antiviral agent such as lamivudine was evaluated prospectively.

Methods
: Twenty‐four patients with chronic hepatitis B who were non‐responders to previous IFN therapy were randomized to receive an IFN and GMCSF (group A, n = 10) or IFN and lamivudine (group B, n = 14) combination for 6 months. The end‐of‐treatment response was assessed by hepatitis B virus (HBV)‐DNA and hepatitis B e antigen (HBeAg) determination.

Results
: All patients successfully completed both the treatment schedules. The mean age, alanine aminotransferase (ALT) levels, liver histology, HBV‐DNA levels and distribution of HBV genotypes were comparable between the two groups. At the end of treatment there was a significant decrease in mean ALT levels. The HBV‐DNA and HBeAg loss was seen in six of 10 (60%) patients in group A and in seven of 14 (50%) patients in group B. During a mean follow‐up of 15 ± 3 months, two of six (33%) patients in group A and three of seven (43%) patients in group B relapsed with HBV‐DNA and HBeAg positivity, which meant an overall sustained response of 40% and 28%, respectively. None of the factors such as HBV viral load, ALT levels or liver histology could predict the non‐response to combination therapy or occurrence of relapse. There was a trend in patients with genotype A compared with genotype D towards non‐response to therapy, although the difference was not significant.

Conclusions
: The combination of IFN plus GMCSF or lamivudine was effective in non‐responders to IFN monotherapy. Larger studies using such combination therapies would be helpful in improving treatment strategies for chronic hepatitis B.

© 2002 Blackwell Publishing Asia Pty Ltd
High, but not low, dietary retinoids aggravate manifestation of rat liver fibrosis
Authors: VOLLMAR BRIGETTE , HECKMANN CHRISTINE , RICHTER SVEN , MENGER MICHAEL D
Published: March 2003

Abstract
Background
: Although there is strong implication that retinoids regulate Ito cell proliferation and collagen synthesis, results from in vivo studies on the relationship between vitamin A and liver fibrosis are conflicting. The present study focuses on the role of vitamin A in carbon tetrachloride (CCl4)‐induced fibrosis by chronic feeding of rats with either a vitamin A‐supplemented or ‐depleted diet.

Methods and results
: In animals with high dietary hepatic retinoid levels, liver fibrosis was more pronounced and was associated with an increased CCl4‐toxicity resulting in high mortality (73%). Enhanced liver fibrosis was confirmed by in vivo fluorescence microscopic determination of both collagen deposits (7.4 ± 1.1 vs 3.9 ± 0.3% in high vitamin A diet‐fed and standard diet‐fed fibrotic animals, respectively; P < 0.05) and rarefication of sinusoids (1.5 ± 0.2 vs 2.4 ± 0.2 sinusoids/200 µm in high vitamin A diet‐fed and standard diet‐fed fibrotic animals, respectively; P < 0.05). It was further associated with decreased bile flow and increased parenchymal cell damage. CCl4 reduced hepatic retinoid levels in high vitamin A diet‐fed animals, but restored hepatic retinoid levels in animals fed with a vitamin A‐deficient diet, implying major interference of vitamin A metabolism with hepatotoxic agents such as CCl4. Low vitamin A feeding did not modulate liver fibrogenesis and caused no mortality.

Conclusions
: These results show that the vitamin A status of the liver plays an important role in liver fibrogenesis. While dietary vitamin A shortage does not promote liver fibrogenesis, high levels of vitamin A have the potential to increase systemic and hepatic toxicity of CCl4. Thus, the narrow therapeutic window for nutritional vitamin A substitution must take into account that liver fibrotic patients may display enhanced susceptibility to the adverse effects of vitamin A.

© 2002 Blackwell Publishing Asia Pty Ltd
Hepatic nodules with early enhancement during computed tomography portography: Report of six cases
Authors: TAKAYASU KENICHI , MURAMATSU YUKIO , WAKAO FUMIHIKO , MIZUGUCHI YASUNORI , IWATA RYOKO , MAEDA TETSUO , MORIYAMA NORIYUKI , SAKAMOTO MICHIIE
Published: March 2003

Abstract
Aim:
To study the clinicopathologic characteristics of hepatic nodular lesions with high attenuation (increased portal blood flow) compared with surrounding hepatic parenchyma on computed tomography (CT) during arterial portography (CTAP).

Methods
:  For six lesions found in six patients demonstrated as a high‐attenuated mass by CTAP, CT during hepatic arteriography (CTHA; n = 3 patients), digital subtraction hepatic arteriography (n = 6) and conventional helical CT (n = 6) were evaluated retrospectively and compared with histopathologic findings (n = 4). Pathologic diagnosis was atypical adenomatous hyperplasia, nodule‐in‐nodule hepatocellular carcinoma (HCC) in one resected lesion each and overt HCC in two biopsied lesions. Two patients did not undergo any therapy and were followed up.

Results
:  The average size of lesions was 2.2 cm (range 1.2–3.5 cm). The CTAP revealed high attenuation in all six lesions; entirely within the lesion (n = 4 lesions) or peripherally with a central low attenuation (n = 2). In contrast, CTHA showed low attenuated lesions; entirely within the mass (n = 2) or peripherally with a central high‐attenuated spot (n = 1). Hepatic arteriogram revealed only two hypervascular lesions; entirely and partially in one each. In the arterial phase of helical CT, all but one lesion were iso‐ or hypo‐attenuated. In two patients who were followed up to 39 and 55 months without therapy, neither tumor growth nor hemodynamic change of the lesion was recognized on CT.

Conclusions:

 
Even though the incidence of hepatic nodular lesions demonstrated as high attenuating on CTAP is low, all but one lesion in the current series showed iso‐ or hypo‐attenuation on CTHA and/or helical CT, suggesting the hemodynamics are reciprocal between CTAP and CTHA. One exceptional lesion that showed high attenuation on both CTAP and conventional CT was pathologically advanced HCC. Based on the follow‐up study of two untreated patients, this kind of lesion with high attenuation on CTAP seems to grow slowly.

© 2002 Blackwell Publishing Asia Pty Ltd
Dysplasia and carcinoma development in a repeated dextran sulfate sodium‐induced colitis model
Authors: Okayasu Isao , Yamada Masahiro , Mikami Tetuo , Yoshida Tsutomu , Kanno Jun , Ohkusa Toshifumi
Published: March 2003

Background: As an important mechanism underlying the increased risk of colorectal carcinoma development in patients with long‐standing ulcerative colitis, promotion as a result of the regenerative process has been proposed. In the present study, a dysplasia‐carcinoma sequence in a novel repeated colitis model in mice is documented.

Methods: Repeated colitis was induced by nine administration cycles of 3% dextran sulfate sodium (DSS; molecular weight, 54 000): each administration cycle comprised 3% DSS for 7 days followed by distilled water for the subsequent 14 days, to give conditions similar to the clinically observed active and remission phases in humans.

Results: Multiple colorectal tumors (nine low‐ and four high‐grade dysplasias and two carcinomas) developed in 25 mice. These neoplastic lesions consisted of tubular structures, presenting as various types of elevated, flat and depressed tumor, similar to those in ulcerative colitis patients. A time‐course study with assessment of the severity of colitis and in vivo bromodeoxyuridine uptake during a single 3% DSS administration cycle revealed a high level of regenerative activity in the colitis‐affected mucosal epithelia.

Conclusion: Thus, with the present repeated colitis model, regeneration and neoplastic lesions were apparent, the biological features of which provide evidence of a colorectal dysplasia–invasive carcinoma sequence in ulcerative colitis.
A case of pseudotumorous pancreatitis that presented unique pancreatoscopic findings with the peroral electronic pancreatoscope
Authors: KODAMA TADASHI , ABE MITSUMASA , SATO HIDEKI , IMAMURA YOICHI , KOSHITANI TATSUYA , KATO KEIMEI , UEHIRA HIROSHI , YAMANE YUKIO , HORII YOSHIYUKI , YAMAGISHI MARIKO , YAMAGISHI HISAKAZU
Published: March 2003

Abstract  A 49‐year‐old man was admitted to Hospital of Kyoto Prefectural University of Medicine complaining of epigastralgia and jaundice. There was a tumor (approximately 30 mm) in the pancreatic head on ultrasound, computed tomography and magnetic resonance imaging. Endoscopic retrograde cholangiopancreatography revealed a stenosis of the main pancreatic duct in the head of the pancreas. Pancreatoscopy with the peroral electronic pancreatoscope (PEPS) was performed to differentiate between pseudotumorous pancreatitis (PTP) and pancreatic carcinoma. The PEPS showed non‐erosive erythematous mucosa around the stenosis and this unique finding was different from that of pancreatic carcinoma. Pylorus‐preserving pancreatoduodenectomy was performed under the possible diagnosis of carcinoma. As a result, the diagnosis of PTP was confirmed histopathologically. At present, the diagnosis of PTP is difficult because of similar findings with carcinoma in various imaging procedures. However, we consider that detailed observation and accurate morphologic assessment of the main pancreatic duct with the PEPS has the possibility of differentiating PTP from pancreatic carcinoma.

© 2003 Blackwell Publishing Asia Pty Ltd
Impaired gallbladder mucosal function in aged gallstone patients suppresses gallstone recurrence after successful extracorporeal shockwave lithotripsy
Authors: TAZUMA SUSUMU , NISHIOKA TOMOJI , OCHI HIDENORI , HYOGO HIDEYUKI , SUNAMI YASUSHI , NAKAI KUNIHARU , TSUBOI KAZUHIKO , ASAMOTO YASUMASA , SAKOMOTO MINORU , NUMATA YOSHIHIRO , KANNO KEISHI , YAMAGUCHI ATSUSHI , KOBUKE TOSHIYA , KOMICHI DAISUKE , NONAKA YOSHIHIRO , CHAYAMA KAZUAKI
Published: March 2003

Background:  Absorption of water, as well as emptying of bile, are important functions of the gallbladder. We studied the changes of gallbladder function with age in gallstone patients and their influence on the outcome of extracorporeal shockwave lithotripsy (ESWL).

Methods:  (i) A total of 123 consecutive patients with complete stone clearance by ESWL were examined. Gallbladder emptying was assessed before treatment using intravenous cholecystography. After stone clearance, the recurrence of gallstones was monitored by using ultrasonography. Cox regression analysis was used to determine the risk factors associated with stone recurrence. (ii) Gallbladder bile was sampled from 59 gallstone patients during surgery. Biliary cholesterol, phospholipids, and total bile acids were simultaneously quantified by using gas–liquid chromatography.

Results:  Impaired gallbladder function, but not gallstone recurrence, was more frequently observed in older patients (≥65 years old) than in younger patients (<65 years old). Cox regression analysis revealed that poor gallbladder emptying was an independent predictor of stone recurrence after ESWL in the total study population, but not in the older patients (≥65 years old). Analysis of bile from surgically treated patients with cholesterol stones showed a significantly higher total lipid concentration and a shorter nucleation time in the younger group (<65 years old), but the cholesterol saturation index did not differ between the younger and older groups.

Conclusions:  Our data suggest that the reduced concentrating function of the gallbladder in elderly gallstone patients helps to counteract stone recurrence despite their abnormal gallbladder motility. Therefore, aged gallstone patients may be preferentially treated by a non‐surgical strategy.
End tidal carbon monoxide concentration in childhood haemolytic disorders
Authors: CHAN GCF , LAU YL , YEUNG CY
Published: March 2003

Objectives:

Endogenous carbon monoxide (CO) is produced mainly by heme catabolism. As CO is excreted solely by the lung, a simple technique for measuring the end tidal carbon monoxide (ETCO) level was assessed as a method for screening for haemolytic disease in children.

Methods:

Two end expiratory breath samples were collected from normal children and from children with haemolytic disease using a one way valve connector between a mouth piece and an anaesthetic bag. The samples were analysed by gas chromatography for CO and carbon for dioxide (CO2). The CO2 value was used to normalise the CO value to an alveolar concentration. Carboxyhaemoglobin (HbCO) also was measured in the patient group for correlation analysis with ETCO.

Results:

A total of 21 children with β thalassaemia major, 15 children with other haemolytic diseases (hereditary spherocytosis n=8, haemoglobin H disease n=3 and thalassaemia intermedia n=4) and 23 normal children were studied. The mean ETCO concentrations in the three groups were 3.21 p.p.m., 7.41 p.p.m. and 0.69 p.p.m., respectively, which were significantly different from each other (P<0.0001). There was a significant correlation between ETCO and HbCO in the patient groups (r=0.85; P<0.0001).

Conclusions:

The end expiratory breath collection device is a simple and feasible sample collection method. The results confirm that ETCO can be used clinically to distinguish children with a variety of haemolytic disorders from normal subjects.
Predischarge screening of very low birthweight infants by click evoked otoacoustic emissions
Authors: GILL AW , GOSLING D , KELLY C , WALKER P , WOODERSON S
Published: March 2003

Objective:

To evaluate the role of transient evoked otoacoustic emission (TEOAE) in screening very low birthweight (VLBW) neonatal intensive care unit (NICU) graduates for hearing loss in comparison with visual reinforcement orientation audiology (VROA) at 10 months.

Methodology:

The study population was all VLBW neonatal survivors discharged from a single regional NICU at John Hunter Childrens Hospital (JHCH), Newcastle, New South Wales, Australia, between April 1994 and March 1996. A TEOAE screen was performed prior to discharge and repeated if necessary until a pass was obtained in at least one ear. Infants were further screened by VROA at their local Australian Hearing Services (AHS) office at 10 months corrected age. Repeated TEOAE failures were referred directly for an ENT opinion.

Results: A total of 193 infants were eligible for enrolment during the study period. One hundred and forty‐four (75%) received TEOAE testing. The median age of first screen was 36 weeks gestational age. Ninety‐five (66%) of infants tested passed on a single screen. Of the remaining 49 infants, 26 passed on retesting (overall pass rate 84%). Twenty‐three (16%) were deemed to have failed the TEOAE screen. Of the 121 infants who passed TEOAE, only 67 (55%) completed VROA. Two of these infants have a high frequency sensorineural loss and one of them has been aided. In the 23 who failed TEOAE, nine have subsequently had normal VROA, another, though not tested is clinically normal. three have hearing loss with middle ear disease and eight have confirmed sensorineural deafness, all aided. One infant has died and an infant with Down’s syndrome has been adopted out of the area. It is of interest to note that the eight aided infants are all of less than 28 weeks gestation. If we restrict analysis to infants with completed VROA testing, the TEOAE has a 97% negative predictive value for sensorineural deafness and a 38% positive predictive value.

Conclusions:

This study has highlighted both the prevalence of hearing impairment in the very premature survivors and difficulties in compliance with a VROA based hearing screen. We see an advantage in directing resources towards an early screening test, such as TEOAE, that can be applied while the target population is still captive.
Do children need to be monitored after electric shocks?
Authors: WILSON CM , FATOVICH DM
Published: March 2003

Objective:

To determine whether cardiac monitoring is required in children sustaining electric shock at Australian household voltage.

Methodology:

Records of patients admitted via the Emergency Department of Princess Margaret Hospital for Children, Perth, Australia, for the period 1968–96 were retrospectively reviewed. The initial ECG findings of patients with an electric shock were recorded, and the development of any arrhythmia.

Results:

Forty‐four patients were identified, 40 of whom had sustained a household electrical injury. One patient had an abnormal ECG on admission, none developed an arrhythmia and all survived.

Conclusions:

Routine cardiac monitoring is not required after exposure to Australian household electricity supply if the child is asymptomatic and has a normal ECG on presentation.
Effect of nappy liners on temperature stability in very preterm infants
Authors: Monterosso L , Percival P , Cole J , Evans SF
Published: March 2003

Objective: To determine whether absorbent liners used in posturally supportive cloth nappies influence temperature stability in infants < 31 weeks gestation.

Methodology: Randomized cross‐over trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Twenty‐three infants nursed in incubators on Infant Servo Control were randomly assigned to wear cloth postural support nappies alternately with or without absorbent liners for 24‐h periods over 4 days. Measurements of skin and incubator temperatures were recorded hourly. Times of all nappy changes and infant handling procedures were also recorded.

Results: There was no change in any temperature measurement over time, between days, or between day/night periods. Infants nursed with the liner demonstrated a higher skin temperature (0.04°C), and a lower incubator temperature (1.05°C). A drop in skin temperature of 0.02°C and an increase in incubator temperature of 0.28°C occurred following handling of infants. There was no effect due to sex, gestational age, or actual age of the infants.

Conclusion: Use of an absorbent liner within a cloth postural support nappy promotes better temperature regulation in infants < 31 weeks gestation, by reducing incubator temperature and increasing skin temperature.