bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonographically‐guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis
Authors: SCHREIBER F. , GURAKUQI GCH , PRISTAUTZ H. , TRAUNER M. , SCHNEDL W. 
Published: March 2008

ABSTRACTOver a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone‐free patients showed no further symptoms over the follow‐up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow‐up period.
Estimation of usefulness of N‐butyl‐2‐cyanoacrylate‐lipiodol mixture in transcatheter arterial embolization for urgent control of life‐threatening massive bleeding from gastric or duodenal ulcer
Authors: TOYODA HIDENORI , NAKANO SATOSHI , KUMADA TAKASHI , TAKEDA ISAO , SUGIYAMA KEIICHI , OSADA TOSHIMASA , KIRIYAMA SEIKI 
Published: March 2008

ABSTRACTWe estimated the usefulness of a mixture of N‐butyl‐2‐cyanoacrylate (NBCA) with lipiodol for transcatheter arterial embolization (TAE) used to control massive bleeding from gastric or duodenal ulcer. Thirty patients who had gastric or duodenal ulcers and massive bleeding that was uncontrollable by endoscopic procedures were included in this study. All patients were subjected to TAE (without NBCA in 23 and with NBCA in seven patients). Coils and/or gelfoam were also used. The achievement of haemostasis, occurrence of rebleeding and the time taken for TAE were compared between patients who received TAE without and with NBCA. Eighteen of 23 patients (78.3%) who received TAE without NBCA and six of seven patients (85.7%) who underwent TAE with NBCA achieved complete haemostasis without rebleeding. The time for TAE was significantly shorter in patients who received NBCA compared with those who did not (P= 0.0095). TAE using NBCA or a combination of NBCA and coils achieved a rapid, complete embolization regardless of vascular distribution or arterial diameter. Thus NBCA is considered to be useful as a secondary embolization material in TAE that is urgently conducted to control massive bleeding from gastric or duodenal ulcers.
Portal‐systemic shunting in a patient with normal portal vein pressures and histological evidence of idiopathic portal hypertension
Authors: SUGIMURA TAKASHI , TSUJI YUJI , IBAYASHI HIROSHI , SAKAI HIRONORI , NAWATA HAJIME 
Published: March 2008

ABSTRACTAlthough idiopathic portal hypertension (IPH) is clinically characterized by portal hypertension and marked splenomegaly, we have experienced a case of spontaneous portal‐systemic shunt without splenomegaly in whom the liver histology resembled IPH but with normal portal pressure. We admitted a 64 year old man who had suffered from hepatic encephalopathy for 2 years. Laparoscopy revealed a dark grey liver with a sharp edge and a concave surface. Examination of a liver biopsy specimen revealed peri‐portal fibrosis consistent with IPH. A single, large, portal‐systemic shunt was identified by percutaneous transhepatic portography. The shunt arose from the left gastric vein and flowed through the left renal vein into the inferior vena cava. No varices were identified. There were no morphological changes in the hepatic or portal veins. Portal vein pressure was normal. There was a slight difference between the portal pressure and the wedged hepatic vein pressure, suggesting a presinusoidal block. This case raises important questions concerning the aetiology of IPH and the relationship between portal hypertension and the development of collateral venous circulation.
Control of colonic variceal haemorrhage with a somatostatin analogue
Authors: CHAKRAVARTY BJ , RILEY JW 
Published: March 2008

ABSTRACTA 64 year old caucasian male with known alcoholic liver disease presented with rectal bleeding. The patient bled repeatedly despite resuscitation. A sigmoid colectomy was performed following an angiogram. Large colonic, rectal and mesenteric variceal vessels were noted at surgery. Further bleeding postoperatively was rapidly controlled with octreotide infusion. Octreotide may be as useful in the control of colonic variceal bleeding as it is in the control of oesophageal variceal bleeding.
Paediatric liver transplantation: A 10 year experience in Taiwan
Authors: CHEN CHAO‐LONG , CHEN YAW‐SEN , CHIANG YUAN‐CHENG , CHENG YU‐FAN , HUANG TUNG‐LIANG , ENG HOCK‐LIEW 
Published: March 2008

ABSTRACTBetween March 1984 and August 1994, 13 orthotopic liver transplantations were performed in 13 patients ≤ 25 years of age. The indications included Wilson's disease (n= 7), biliary atresia (n= 4), choledochal cyst (n=1) and hepatitis C cirrhosis (n=1). Technical variants included full‐size (n=11), reduced‐size (n=1) and living‐related (n=1) liver transplantation. These recent technical innovations have offered an expanded donor pool for earlier transplantation, shorter waiting times and excellent quality grafts. Surgical complications occurred in six patients; all required additional surgery. Biliary complications were encountered more commonly in our earlier patients. Our actuarial patient and graft survival rate is 92% at 2 years. The long‐term follow‐up of our liver‐transplanted Wilson's disease patients provides confirmatory evidence that orthotopic liver transplantation cures the underlying metabolic defect with complete normalization of biochemical abnormalities of copper metabolism, reversal of neurological impairments and the disappearance of Kayser‐Fleischer corneal rings. The high rate of patient survival and excellent rehabilitation indicate that with prudent clinical judgement, liver transplantation can be achieved with an acceptable rate of morbidity, mortality and cost in a setting where manpower and donor organs are very limited.
Risk factors for pancreatic cancer in Orientals
Authors: LEE CHI‐TE , CHANG FULL‐YOUNG , LEE SHOU‐DONG 
Published: March 2008

ABSTRACTIn order to assess what the risk factors for patients with pancreatic cancer (PC) in Taiwan are, a retrospective study was undertaken among 282 consecutively enrolled inpatients with confirmed pancreatic cancer within the past 5 years. For comparison, 282 age‐ and sex‐matched controls were consecutively enrolled. A history of smoking, consumption of alcohol, diabetes mellitus, cholecystectomy and gastric surgery were thoroughly reviewed. Smoking and diabetes mellitus were very common among patients with pancreatic cancer compared with controls (P< 0.01). A significant linear trend towards an increased odds ratios (OR) for the development of PC with a higher level of smoking was seen (P<0.001). Diabetes mellitus (DM) also exhibited an increased risk (OR: 2.84; P<0.01), while this risk still existed among those patients who had a diabetic history of more than 3 years. Among 129 histologically established PC patients, smoking remained as a risk factor for PC, while the linear trend with an increasing OR with increasing levels of smoking was confirmed again (P<0.01). DM, particularly over the long‐term, was also a risk factor for those histologically established PC patients. In summary, cigarette smoking and existing diabetes mellitus are probable risk factors for the development of pancreatic cancer in Taiwan.
Case report: Portal‐systemic encephalopathy due to a congenital extrahepatic portosystemic shunt
Authors: KIRIYAMA MASATO , TAKASHIMA SHIGEKI , SAHARA HIROYUKI , KUROSAKA YOSHIYUKI , MATSUSHITA MASAHIRO , AKIYAMA TAKAYOSHI , TOMITA FUJIO , SAITO HITOSHI , KOSAKA TAKEO , KITA ICHIRO , KOJIMA YASUHIKO , TAKEGAWA SHIGERU 
Published: March 2008

ABSTRACTWe present a case of portal‐systemic encephalopathy due to a congenital splenorenal shunt. A 69 year old woman was admitted to hospital because of recurrent episodes of disturbed consciousness. The present episode had begun 3 months prior to admission. Although the patient demonstrated mildly slurred speech, the remainder of her neurological examination was unremarkable. She showed no clinical signs of portal hypertension and her liver function, except for a serum hepaplastin test of 58% and an ICG retention rate of 28% at 15 min, was normal. Her serum ammonium level was 210 μg/dL. The venous phase of a superior mesenteric arteriogram revealed a splenorenal shunt and narrowing of the portal vein, which was 4 mm in diameter. The histological findings, demonstrated by a needle liver biopsy specimen, were consistent with mild fibrosis and lymphocytic infiltration. Following the diagnosis of a splenorenal shunt in the absence of liver cirrhosis, ligature of the shunt was performed with a splenectomy. The portal vein pressure after ligature of the shunt rose from 12.5 to 18.8 mmHg. This shunt was thought to be of congenital origin. The high preoperative serum ammonia concentration decreased to the normal range postoperatively and the serum hepaplastin test and ICG retention rate similarly improved postoperatively. A follow‐up superior mesenteric arteriogram was performed during the venous phase, demonstrating resolution of the shunt and decreased portal vein narrowing. The patient has suffered no further episodes of disturbed consciousness postoperatively.
Complications of percutaneous transhepatic catheterization of the portal venous system in patients with portal hypertension
Authors: OHTA MASAYUKI , HASHIZUME MAKOTO , KAWANAKA HIROFUMI , AKAZAWA KOUHEI , UENO KIICHIRO , TOMIKAWA MORIMASA , KISHIHARA FUMIAKI , TANOUE KAZUO , SUGIMACHI KEIZO 
Published: March 2008

ABSTRACTWe report here complications of percutaneous transhepatic catheterization of the portal venous system in 170 Japanese patients with portal hypertension. All patients underwent percutaneous transhepatic portography and percutaneous transhepatic obliteration of oesophagogastric varices was also performed in 29 patients. After retraction of the catheter, the puncture canal was plugged with gelatin sponge in 150 subjects and with one steel coil in 20 others. The overall complication rate was 16.5%. Intraperitoneal bleeding occurred in 10.6% of patients and 2.9% required blood transfusion. In these patients with intraperitoneal bleeding, the gelatin sponge was used for plugging after retraction of the catheter, while in the 20 patients with a steel coil plug, haemoperitoneum never occurred. Right pleural effusion was recognized in 3.5% of patients, intraperitoneal bile leakage in 1.8% and deterioration of liver function due to arteriovenous fistula in 0.6%. By univariate and multivariate analyses, female gender was the only risk factor for intraperitoneal bleeding among 150 patients investigated by percutaneous transhepatic catheterization of the portal venous system with gelatin sponge plugging. Intraperitoneal bleeding is the most important complication in patients with portal hypertension; it is difficult to predict intraperitoneal bleeding before retraction of the catheter in patients for whom gelatin sponge is used. Thus, for patients undergoing percutaneous transhepatic catheterization of the portal venous system, close follow up is recommended.
Phylogenetic tree‐based epidemiological analysis of hepatitis C virus transmission in a region of Japan with a high prevalence of infection
Authors: HARA TOSHIYA , SETOGUCHI YOICHI , KAJIHARA SUSUMU , YAMAMOTO KYOSUKE , SAKAI TAKAHIRO , INOUE TAKATOSHI , OHBA KENICHI , MIZOKAMI MASASHI 
Published: March 2008

ABSTRACTLocal clustering of hepatitis C virus (HCV) infection has been demonstrated in various regions in Japan. HCV genotypes have now been compared between infected individuals from districts of Saga prefecture with either a high (H district) or low (L district) prevalence of HCV‐seropositivity. The prevalence of HCV genotype 1b was significantly higher (P<0.001) in the H district (45/50; 90%) than in the L district (19/36; 52.8%). A phylogenetic tree was constructed based on the genomic sequences of viral isolates from 20 patients infected with genotype 1b in the H district. Almost all these HCV strains clustered in the same regions of the tree. With regard to risk factors for HCV transmission, the percentage of patients with a history of surgery was significantly higher in the H district than in the L district (58 versus 33.3%; P<0.05). Of 20 patients infected with similar strains of HCV in the H district, 16 (80%) had at least one parenteral risk factor associated with medical care. These results indicate an increased transmission of similar strains of HCV in the H district as a result of nosocomial infection.
Improvement of peripheral blood lymphocyte subsets in primary biliary cirrhosis after ursodeoxycholic acid therapy
Authors: IKEDA TAKAAKI , SATO CHIFUMI , NOGUCHI OSAMU , KOBAYASHI FUMIE , TOZUKA SHINICHI , SAKAMOTO SHIGEMI , MARUMO FUMIAKI 
Published: March 2008

AbstractImmunological abnormalities frequently observed in patients with primary biliary cirrhosis are considered to be related to the pathogenesis of this disease. We performed a prospective trial to evaluate whether immune mechanisms play a role in the effectiveness of ursodeoxycholic acid (UDCA) therapy. Fifteen female patients with primary biliary cirrhosis were followed for 1 year and were then treated with UDCA (600 mg/day) for another year. Laboratory tests, including peripheral blood lymphocyte subsets assessed by dual colour fluorescence analysis using monoclonal antibodies against respective T cell markers, were evaluated at the beginning of the study, at the start of therapy and at the end of therapy. In primary biliary cirrhosis, the proportion of cytotoxic T cells, suppressor inducer T cells and αβ‐receptor bearing T cells were significantly lower than in healthy controls. No significant changes were observed in the proportions during the year before the therapy. These reductions, however, recovered to normal ranges after 1 year of UDCA therapy. These changes were associated with an improvement in the serum levels of aspartate aminotransferase, alkaline phosphatase, γ‐globulin and IgM. The close correlation between the improvement in the imbalance of lymphocyte subsets after the therapy and the clinical status suggests that an immunological process may play a role in the effectiveness of therapy in primary biliary cirrhosis.
UDP glucuronosyltransferase in the cirrhotic rat liver
Authors: DEBINSKI HENRY S , MACKENZIE PETER I , LEE C SOON , MASHFORD M LAURENCE , DANKS JANINE A , TEPHLY THOMAS R , GREEN MITCHELL , DESMOND PAUL V 
Published: March 2008

AbstractIn patients with cirrhosis, the elimination of drugs metabolized by glucuronidation is relatively preserved, in comparison with the metabolism of drugs by oxidation. This study explores this phenomenon at a molecular level. In cirrhotic rat livers the content of UDP‐glucuronosyltransferase (UGT) was examined by immunohistochemistry and immunoblotting using three antibodies: (i) a polyclonal antibody directed against a broad number of UGT isoforms from both family 1 and family 2; (ii) a family 2‐specific antibody; and a (iii) family 1‐specific antibody. The steady state mRNA level of UGT of a family 2 isoform was also detected by northern blot analysis. The results demonstrate normal or increased UGT protein by immunohistochemistry and immunoblot in cirrhotic livers compared with controls. This was accompanied by increased steady state mRNA encoding the UGT isoform UGT2B1. In contrast, an isoform of cytochrome P450 (CYP2C11) was reduced markedly in both immunohistochemical staining and immunoblot analysis. These results suggest that in cirrhosis there is a comparative increase or at least a maintenance of UGT enzyme content and that this most likely occurs at a pretranslational level.
Classical Kaposi's: A rare cause of gastrointestinal haemorrhage
Authors: CHAPMAN SM , BELL SJ , CHEN S. , COSOLO W. 
Published: March 2008

AbstractClassical Kaposi's sarcoma (KS) is an indolent neoplasm involving mucocutaneous sites predominantly in elderly Mediterranean or Jewish persons. Whilst gastrointestinal involvement is common, it is usually asymptomatic. This case report presents a case of massive gastrointestinal haemorrhage in a patient with stable cutaneous disease and outlines options for the investigation and management of this rare complication.
CASE REPORT: Successful palliative treatment with intraperitoneal OK‐432 injection for epithelioid haemangioendothelioma presenting with intractable ascites
Authors: WEI SHU‐CHEN , YANG PEI‐MING , CHEN CHIEN‐HUNG , CHU JAN‐SHOW , CHEN DING‐SHINN 
Published: March 2008

ABSTRACTEpithelioid haemangioendothelioma is an unusual type of endothelium‐derived vascular tumour of borderline malignancy, which has high variability in clinical presentations, depending on the primary site of involvement. We report on a 20‐year‐old woman who presented with progressive abdominal fullness for 6 months. Multiple lung and liver nodules with pleural effusion and profuse ascites were found. The diagnosis of epithelioid haemangioendothelioma was made after wedge biopsy of the liver. The ascites was intractable and refractory to strong diuretic therapy and repeated paracentesis. Therefore, six courses of intraperitoneal injection of OK‐432 were administered. The ascites subsided to a minimal amount after treatment and the patient remained symptom‐free for approximately 8 months. The ascites recurred later and another three courses of intraperitoneal injection of OK‐432 were administered. The ascites disappeared again. The patient has remained symptom‐free since the end of the second period of treatment.
Cyclosporine therapy affects aminotransferase activity but not hepatitis C virus RNA levels in chronic hepatitis C
Authors: KAKUMU SHINICHI , TAKAYANAGI MASAHIRO , IWATA KAZUO , OKUMURA AKIHIKO , AIYAMA TOSHIYUKI , ISHIKAWA TETSUYA , NADAI MASAYUKI , YOSHIOKA KENTARO 
Published: March 2008

ABSTRACTInterferon (IFN) therapy is of proven efficacy in chronic hepatitis C, but it is not universally effective and is often limited by side effects. Cyclosporine A (CsA) is a potent immunosuppressant widely used in organ transplantation. We conducted a pilot study to determine whether CsA therapy could affect aminotransferase activity and hepatitis C virus RNA levels in patients with chronic hepatitis C. Cyclosporine A was administered to 10 patients (mean age of 59 years; male: female = 9:1) who did not respond to IFN therapy previously and who had elevated serum alanine aminotransferase (ALT) values for at least 6 months. All patients were positive for HCV‐RNA by RT‐PCR with genotype 1b. Their mean duration of hepatitis was 15 years. Oral CsA was given for 3 months in a dose that was increased at 1 month intervals from 1.5–2.0 to 2.0–3.0 and 3.0–4.0 mg/kg per day. All patients completed the treatment schedule, although two patients developed mild non‐symptomatic hypertension. Serum ALT levels gradually decreased in all but one patient. The mean percentage decrease was 59.5% at the end of therapy (from 153 ± 82 to 62 ± 48 IU/L; P < 0.02). The ALT levels fell to the normal range in five patients, although once therapy was discontinued the enzyme levels tended to return to pretreatment levels. Serum aspartate aminotransferase and g‐glutamyl transpeptidase levels similarly decreased. The serum HCV‐RNA titre, determined by competitive RT‐PCR, did not change in any patient throughout the study period. There were no appreciable alterations in other laboratory tests, such as serum creatinine levels and lymphocyte subsets, except for an increase in serum alkaline phosphatase levels. These findings suggest that CsA, even in a relatively low dose, reduces serum aminotransferase levels without serious side effects in patients with chronic‐hepatitis C, although an antiviral effect was not noted.
Duodenal erosions and ulcers in patients with pancreatobiliary obstruction
Authors: ABBAS ZAIGHAM , KHAN ABDUL HALEEM , JAFRI SM WASIM , HAMID SAEED SADIQ , SHAH SYED HASNAIN ALI , ABID SHAHAB , QURESHI JAZIBEH ALEEM 
Published: March 2008

ABSTRACTIn order to determine whether obstructive pancreatobiliary lesions increase the risk of duodenal erosions and ulcers, the duodenal mucosa of patients with these lesions were prospectively examined before endoscopic retrograde cholangiopancreatography (ERCP). During the study period, 133 patients underwent ERCP for various reasons in the Department of Medicine, The Aga Khan University Hospital. One hundred and twenty‐three patients were eligible for final analysis. Sixty‐five patients with bilirubin ≥ 35 μmol/L and alkaline phosphatase ≥ 2.5 times normal levels along with radiological evidence of pancreatobiliary obstruction were included in the obstruction group. Fifty‐eight patients who did not fulfil these criteria were used in the control group. Acid peptic lesions, which included erosions and ulcers, were seen in 16 patients of the obstruction group and four patients of the control group (P=0.016, odds ratio (OR) = 4.41). Patients with carcinoma of the pancreas had a greater number of lesions than the rest of the obstruction group (P= 0.001, OR=8.75). Individual variables like age, sex, serum bilirubin, alanine aminotransferase, alkaline phosphatase, amylase levels, and duration of jaundice did not increase the vulnerability to acid peptic injury. The degree of obstruction multiplied by duration of jaundice (alkaline phosphatase x days) increased the susceptibility for duodenal disease (P=0.047). From this data it was concluded that patients with obstructive pancreatobiliary lesions are more prone to acid peptic duodenal lesions.
Gastric duplication: Endoscopic appearance and clinical features
Authors: POKORNY CHRISTOPHER S , COOK WARWICK J , DILLEY ANTHONY 
Published: March 2008

ABSTRACTThe case of a 13‐year‐old female presenting with a 6 week history of significant vomiting resulting from a gastric duplication is described. At endoscopy, an antral mass which appeared to change in size and site with peristalsis was evident. Although rare, these lesions need to be considered in the differential diagnosis of patients presenting with symptoms suggestive of gastric outlet obstruction. However, in the majority of cases, the diagnosis is rarely made prior to surgery.