bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethanol injection therapy of an isolated bile duct associated with a biliary‐cutaneous fistula
Authors: MATSUMOTO TOSHIFUMI , IWAKI KENTARO , HAGINO YOSHIAKI , KAWANO KATSUNORI , KITANO SEIGO , TOMONARI KEN‐ICHIRO , MATSUMOTO SHUNRO , MORI HIROMIJ 
Published: March 2003

Abstract
Bile leakage after hepatic resection often results in the formation of a biliary‐cutaneous fistula. Such a fistula, when caused by an isolated bile duct in the remnant liver, can be intractable. We report a successful case of ethanol injection therapy of an isolated bile duct. A 73‐year‐old man underwent right hepatic resection for hepatocellular carcinoma. Bile leakage occurred after surgery, and the patient developed a biliary‐cutaneous fistula. Fistulography revealed an isolated bile duct in the remnant portion of the caudate lobe without communication to the main biliary system. As conservative management with simple drainage was ineffective, injection therapy with ethanol was performed with a balloon occlusion catheter. After 11 therapy sessions, the bile duct was eradicated, and the biliary‐ cutaneous fistula was completely healed. The post‐treatment course was uneventful. Ethanol injection therapy can be a choice for management of patients with a biliary fistula caused by an isolated bile duct.© 2002 Blackwell Publishing Asia Pty Ltd
Polymorphism in alcohol‐metabolizing enzymes, glutathione S‐transferases and apolipoprotein E and susceptibility to alcohol‐induced cirrhosis and chronic pancreatitis
Authors: FRENZER ANDREAS , BUTLER WENDY J , NORTON IAN D , WILSON JEREMY S , APTE MINOTI V , PIROLA ROMANO C , RYAN PHILIP , ROBERTS‐THOMSON IAN C 
Published: March 2003

AbstractBackground and Aim Susceptibility to organ damage induced by alcohol may be due to inherited variation (polymorphism) in ethanol‐metabolizing enzymes, or to polymorphisms affecting free radical or lipid metabolism mediated by enzymes such as glutathione S‐transferases and apolipoprotein E. The aim was to compare the genotype frequencies of alcohol dehydrogenase‐2 (ADH2), ADH3, aldehyde dehydrogenase‐2 (ALDH2), cytochrome P450‐2E1 (CYP2E1), glutathione S‐transferase‐M1 (GSTM1), GSTT1, and apolipoprotein E in patients with alcoholic cirrhosis and alcoholic chronic pancreatitis to those in control groups.Patients and Methods The case–control study was restricted to Caucasian adults: 57 with alcoholic cirrhosis, 71 with alcoholic chronic pancreatitis, 57 alcoholics without apparent organ damage and 200 healthy blood donors. Genotypes were determined by restriction fragment length polymorphism after amplification of genomic DNA by polymerase chain reaction.Results The genotype ADH3*2/*2 was more frequent in patients with cirrhosis (40%) than blood donors (12%; OR 4.92, 95% CI 2.36–10.31) and patients with chronic pancreatitis (8%; OR 7.33, 95% CI 2.54–23.78) but was not significantly different from alcoholic controls (23%; OR 2.27, 95% CI 0.95–5.66). Patients with cirrhosis also had a higher frequency (P < 0.05) of ADH2*1/*1 (100%) than blood donors (92%) and those with chronic pancreatitis (93%). The frequencies of genotypes of ALDH2, CYP2E1, GSTM1, GSTT1 and apolipoprotein E were similar in all groups.Conclusion Alcoholic cirrhosis but not alcoholic chronic pancreatitis is associated with ADH3*2/*2 and perhaps with ADH2*1/*1. Both genes encode less active alcohol‐metabolizing enzymes that may be associated with cirrhosis because of delayed formation of acetaldehyde (with higher intakes of alcohol), or diversion of alcohol metabolism through pathways other than ADH.
Introduction of lamivudine for the treatment of chronic hepatitis B: Expected clinical and economic outcomes based on 4‐year clinical trial data
Authors: CROWLEY STEVEN , TOGNARINI DAVID , DESMOND PAUL , LEES MICHAEL , SAAL GAURI 
Published: March 2003

AbstractBackground Chronic hepatitis B (CHB) is associated with a significant burden of illness and treatment involves substantial health‐care costs. This study estimates clinical outcomes and cost‐effectiveness of lamivudine compared with other treatment scenarios for CHB, from an Australian health‐care provider perspective.Methods A two‐step modeling approach depicted clinical progression of hepatitis B in hypothetical patient cohorts using three different treatment scenarios: scenario A, lamivudine and α‐interferon (IFN‐α) available; scenario B, IFN‐α available only; and scenario C, no treatment available. Assumptions were based on clinical trials, published studies, a hepatologist’s questionnaire and an expert panel follow up. One‐year clinical outcomes and costs were estimated using a decision tree, while lifetime costs and outcomes were estimated using available clinical trial data for lamivudine (up to 4 years therapy duration) and a Markov model.Results The analysis considered only patients with pretreatment elevated alanine aminotransferase levels ≥ 2 × upper limit of normal. In the short term, the introduction of lamivudine is expected to result in almost 3.5 times more CHB patients receiving therapy (lamivudine or IFN‐α) compared to IFN‐α only (67% compared to 20%, respectively). Hence, scenario A subsequently doubled the seroconver‐sion rate. The incremental cost‐effectiveness ratio was $A3341 per additional seroconversion. Also, non‐seroconverted lamivudine patients are less likely to progress to cirrhosis than those receiving IFN‐α/no treatment. One‐year progression to cirrhosis was estimated at 5.1% with scenario A, compared to 12.2% and 12.7%, scenarios B and C, respectively. From the long‐term analysis, lamivudine is expected to increase life expectancy by years and reduce the lifetime risk of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma by 6%, 12% and 12%, respectively. Additionally, the introduction of lamivudine decreases lifetime costs by $548, thus making it a cost‐saving and life‐extending strategy. In both short‐ and long‐term models, worst case scenarios in sensitivity analyses still associate lamivudine with a favorable cost‐effectiveness ratio.Conclusion Introduction of lamivudine is expected to improve health outcomes in CHB patients, resulting in overall savings in health‐care costs. In this model, compared with IFN‐α only and no treatment, lamivudine allowed more CHB patients to be treated, increased the seroconversion rate, delayed disease progression and prolonged life expectancy.
Extrahepatic manifestations of cholestasis
Authors: Glasova Helena , Beuers Ulrich 
Published: March 2003

Abstract  Pruritus, fatigue and metabolic bone disease represent three major extrahepatic manifestations of chronic cholestatic liver disease that considerably affect the patient"s quality of life. The present article reviews pathogenetic aspects of and current therapeutic approaches to extrahepatic manifestations of cholestatic liver disease. Pathogenesis of pruritus of cholestasis remains poorly understood. The involvement of putative peripherally acting pruritogens, such as bile acids or endogenous opioids, is being discussed. More recently, central mechanisms, including an increased central opioidergic tone and pertubations in the serotonergic system have been proposed. Treatment of the underlying disease is beneficial also for the control of cholestasis‐associated pruritus. Current therapeutic recommendations include ursodeoxycholic acid, cholestyramine, rifampicin and opioid antagonists. Liver transplantation may be indicated when severe pruritus is refractory to medical treatment. Fatigue is being recognized as the most frequent and one of the most disabling complaints in chronic cholestasis. Fatigue is presumably of central origin and its association with other neuropsychiatric disorders (e.g. depression, obsessive –compulsive disorders) is consistent with defective central neurotransmission. No specific therapies are currently available and a healthy lifestyle, regular sleep and avoidance of unnecessary stress and other precipiting factors are recommended. Antidepressant therapy may be warranted in selected patients. Osteopenia and osteoporosis are common in chronic cholestatic liver disease, whereas osteomalacia is rare. The pathophysiology of cholestasis‐associated metabolic bone disease is regarded as multifactorial. Therapeutic recommendations include regular exercise, calcium and vitamin D supplementation in late stage disease, hormone replacement therapy in postmenopausal women and bisphosphonates.© 2002 Blackwell Publishing Asia Pty Ltd
Gastric cancer: Laboratory bench to clinic
Authors: Houghton Jeanmarie , Fox James G , Wang Timothy C 
Published: March 2003

Abstract
Gastric cancer is the second most common cause of cancer‐related mortality worldwide and the 14th overall cause of death. Detection of disease usually occurs at an advanced stage and overall survival rates for gastric cancer are poor. Our current model for gastric cancer progression clearly maintains Helicobacter infection as the primary inducer of gastric metaplastic and neoplastic disease. Helicobacter pylori is a ubiquitous organism, infecting more than half the world’s population. It has been suggested that this infection directly contributes to the formation of gastric cancer in up to 80% of cases; however, gastric malignancy develops in only a subset (< 1%) of infected patients. Therefore, predisposition to Helicobacter‐associated gastric cancer is most likely multifactorial, including the interaction of bacterial, host and environmental components. Our understanding of how the organism interacts with the gastric mucosa and synergizes with dietary and other environmental factors to induce malignant mucosal changes is evolving. Indeed, H. pylori has direct effects on the gastric mucosa, but the major factor in disease progression appears to be a robust host Th1 immune response in the setting of a permissive environment. In combination, these factors predispose to the formation of atrophy, metaplasia and gastric cancer. Understanding the interaction of the bacterium with the host and the environment can potentially identify patients most at risk. Identifying potentially removable factors (in addition to H. pylori infection) in the acquisition and progression of neoplastic disease may provide targets for early intervention and prevention strategies.© 2002 Blackwell Publishing Asia Pty Ltd
Randomized open trial for comparison of proton pump inhibitors in triple therapy for Helicobacter pylori infection in relation to CYP2C19 genotype
Authors: INABA TOMOKI , MIZUNO MOTOWO , KAWAI KOZOU , YOKOTA KENJI , OGUMA KEIJI , MIYOSHI MASATSUGU , TAKE SUSUMU , OKADA HIROYUKI , TSUJI TAKAO 
Published: March 2003

Abstract
Background and aims
: Genetic polymorphism of cytochrome P450 (CYP) 2C19 influences the efficacy of Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI) and amoxicillin. However, in triple therapy (PPI plus amoxicillin and clarithromycin), little is known about the impact of CYP2C19 polymorphism, or the use of rabeprazole, which is not well metabolized by CYP2C19. The efficacy of three PPI (omeprazole, lansoprazole, and rabeprazole) in a 1‐week triple regimen were compared in relation to CYP2C19 polymorphism.
Method
: One hundred and eighty‐three patients were randomized to receive one of the following regimens: amoxicillin 500 mg t.i.d., clarithromycin 200 mg t.i.d., and PPI (omeprazole 20 mg, lansoprazole 30 mg, or rabeprazole 10 mg) b.i.d. CYP2C19 polymorphism was analyzed by PCR restriction fragment length polymorphism.
Results
: Intention‐to‐treat‐based overall cure rates for omeprazole, lansoprazole or rabeprazole regimens were 83.1% (95% confidence interval (CI): 69–89%), 86.7% (CI: 75–93%), and 76.6% (CI: 64–85%), respectively, without significant difference. The cure rate of the rabeprazole regimen (but not the lansoprazole or omeprazole regimens) tended to be correlated with CYP2C19 genotypes (P = 0.076). In patients with a homozygous extensive metabolizer genotype, the per protocol‐based cure rate with rabeprazole (62.5%) was significantly lower than that with lansoprazole (90.0%; P = 0.038).
Conclusion
: The overall cure rate of 1‐week triple therapy for H. pylori eradication was not significantly different between regimens with omeprazole, lansoprazole or rabeprazole, but the impact of CYP2C19 genetic polymorphism on the cure rate appeared to differ between these PPI.© 2002 Blackwell Publishing Asia Pty Ltd
Risk factors for recurrent urinary tract infection in preschool children
Authors: Panaretto KS , Craig JC , Knight JF , Howman‐Giles R , Sureshkumar P , Roy LP 
Published: March 2003

Objective: Children with urinary tract infections (UTI) are at risk of renal scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in children and the role of recurrent UTI in renal scarring. Methodology: A group of 290 children under 5 years of age with a first symptomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was repeated 1 year later. Two hundred and sixty‐one children (90%) were followed up at 1 year. Results: There were 46 confirmed recurrent infections in 34 children, a recurrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UTI (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell throughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) of the group with recurrent UTI, 69/256 (27%) without recurrence. Urinary tract infection was significantly associated with bilateral and intrarenal reflux; grade 3–5 reflux independently predicted for recurrent UTI (OR: 3.5). Recurrent UTI was significantly associated with high grade DMSA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year. Conclusions: The independent risk factors for recurrent UTI identified by this study were an age of less than 6 months at the index UTI and grade 3–5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine infection.
Parent reported allergy and anaphylaxis in 4173 South Australian children
Authors: Boros CA , Kay D , Gold MS 
Published: March 2003

Objectives: To determine the prevalence of parent reported allergy and anaphylaxis in a sample of children and to investigate the first aid management of anaphylaxis in the schools and preschools that these children attend. Methods: The study sample comprised 4173 South Australian children aged 3–17 years. Information was collected regarding parent‐reported allergy and anaphylaxis. All children with known anaphylaxis were contacted and an attempt was made to contact those with reports of allergy to ascertain if these children had anaphylaxis. A telephone questionnaire was used to verify reports of anaphylaxis and determine the cause, severity and school first aid management of anaphylaxis. Results: The rate of parent reported allergy and anaphylaxis was 7.3 and 0.59 per 100 children, respectively. Two‐thirds of children with anaphylaxis did not have emergency medication available at school, an emergency action plan, or a teacher on site able to administer adrenaline for first aid use. Conclusions: Children attending preschool or school may have had a past history of anaphylaxis. Arrangements for first aid management of these children while in this environment are often inadequate.
Does maternal obesity adversely affect breastfeeding initiation and duration?
Authors: Donath Sm , Amir Lh 
Published: March 2003

Objective: To examine the relationship between maternal obesity and the initiation and duration of breastfeeding. Methods: Analysis was made of the 1995 National Health Survey, in which personal interviews were conducted on a multistage area sample of private dwellings and a list sample of non‐private dwellings in all states and territories of Australia. Mothers between the ages of 17 and 50 years (n = 1991) with children under the age of 4 years in 1995 participated in the study. Results: Of the group of mothers with a body mass index (BMI) of 20–25, 89.2% (95% confidence interval (CI) 87.4–91.0) initiated breastfeeding, compared with 82.3% (95% CI 77.6–87.0) of mothers with a BMI of 30 or more. There was also a significant difference between the mean and median duration of breastfeeding of obese and non‐obese mothers (BMI 30 and over, < 25, respectively). These differences remained significant when maternal smoking, age and other sociodemographic factors were taken into consideration. Conclusions: Health professionals should be aware that obese women may be at increased risk of not breastfeeding or stopping breastfeeding prematurely.
Outcome of primary vesicoureteric reflux detected following fetal renal pelvic dilatation
Authors: McIlroy P J , Abbott G D , Anderson N G , Turner J G , Mogridge N , Wells J E 
Published: March 2003

Objective: Postnatal investigation of mild degrees of fetal hydronephrosis has allowed subsequent detection of infants with vesicoureteric reflux (VUR). This study was designed to provide short to medium term information on such infants who had primary VUR, the rates of renal damage and progression over time, the risk factors for such damage and to compare the characteristics of those who had mild dilatation of the fetal renal pelvis (4–9 mm) with those who had moderate–severe dilatation (≥ 10 mm). Methodology: Since June 1989, infants whose antenatal sonography had identified a fetal renal pelvis with an anteroposterior diameter of ≥ 4 mm were investigated postnatally with renal ultrasonography and micturating cystourethrogram (MCU), and placed on antimicrobial prophylaxis. Those with VUR received 99mTc‐dimercaptosuccinic acid (DMSA) scintigraphy. Infants were followed until discharge based on resolution of VUR, surgery, or low grade VUR. A 5.5 year cohort between June 1989 and December 1994 formed the study population. A review of notes and clinical review (if still under follow up) was undertaken. Vesicoureteric reflux on MCU was regraded according to the International Classification, and reflux nephropathy on DMSA scans was regraded according to criteria proposed by Goldraich. Regression analysis was used to assess risk factors for renal damage. Results: There were 69 infants (37 girls, 32 boys) who were identified with primary VUR, with 37/69 having bilateral reflux. Eight had a urinary tract infection during the follow‐up period. There was a broad distribution of grades of reflux detected (Grades I – 3, Grades II – 23, Grades III – 19, Grades IV – 17, Grades V – 7). 99mTc‐dimercaptosuccinic acid scans on 57/69 (83%) demonstrated renal damage in eight infants (14%). This was predominantly global contraction of function. No progression of renal damage was seen over 2–7 years. Regression analysis showed a strong association between Grades IV, V reflux and the presence of renal damage (P < 0.001). Review of the degrees of fetal renal pelvic dilatation showed that 60/69 infants were detected because of mild (4–9 mm) dilatation. The majority (43/60) had lower grades of reflux (Grades I, II, 3), but there was no obvious cut‐off between 4 and 9 mm that could predict high grade VUR (Grades IV, V). Conclusions: The use of 4 mm to define an abnormal fetal renal pelvis allows a much larger group of infants with high grade primary VUR to be detected than if a higher cut‐off measurement is used. Although it also detects many more infants with low grade primary VUR, there is no obvious cut‐off point at which this effect predominates. Progressive renal damage was not seen in follow up of up to 7 years of age. Renal damage on DMSA scanning in this group is almost exclusively a pattern of global contraction of function. The presence of high‐grade VUR appears to be the only important factor in predicting the presence of renal damage.
Meningococcal vaccination for adolescents? An economic evaluation in Victoria
Authors: Skull SA , Butler JRG 
Published: March 2003

Objective: To undertake an economic evaluation of the options for vaccination of adolescents using meningococcal polysaccharide vaccine based on Victorian data. Methodology: Cost‐effectiveness and cost–benefit analyses of three options for vaccination were undertaken for hypothetical populations aged 15–19 years. Baseline analyses assumed a single year of programme implementation and vaccine protection of 5 years. Sensitivity analyses of key variables were performed. Outcomes included the number of people vaccinated, cases averted, life years saved and disability adjusted life years (DALY) averted. Lost earnings avoided were included as a measure of vaccination benefit in cost–benefit analyses. Results: Vaccination of people in Years 10–12 (secondary school) and first year university within a defined population with a high rate of disease was the most cost‐effective option. Excluding direct cost savings and compared with no vaccination, this resulted in a discounted cost per DALY avoided of $17 646 and benefits exceeding costs in discounted terms. The ‘break‐even’ incidence rate for this option in the cost–benefit analysis was 11.9/100 000. Conclusions: Economic evidence favours the use of vaccination within well‐defined populations with a high rate of disease.
Why paediatricians rural out going to the country but support opportunities for change
Authors: Gorton SM , Buettner PG 
Published: March 2003

Objectives: To determine the knowledge of vacant country specialist positions, the main barriers to filling country specialist positions, the acceptance of hypothetical creative employment models and to gain understanding of what would it take for respondents to accept a country position. Methodology: Mailed self‐report questionnaires to all 103 Queensland paediatricians and finishing paediatric trainees (response rate 93.1%) to explore reasons for the long‐term vacancy of the Staff Paediatrician position at the Mount Isa Base Hospital, North‐west Queensland, Australia. Results: Of the respondents, 87.4% were aware of the vacant position. The lack of adequate locum cover for leave (97.8%), on‐call load (92.2%), professional isolation (91.4%), and family commitments (91.4%) were identified as the four most frequently recognized recruitment barriers. Of the respondents, 30.2% said they could be attracted to such a position if they were guaranteed the ability to return to their present post in 2 years, 30.7% said they could be attracted to a rural exchange, and 73.1% suggested the position would be more attractive to new Fellows if at the end of a 2‐year period they were guaranteed some Visiting Medical Officer sessions or a temporary Staff Paediatrician position at a tertiary centre. Significantly, fewer of the 30–39‐years age group said available job opportunities for their spouse made it impossible for them to consider the advertised position, compared to older age groups (P = 0.003). In response to the question ‘What would it take for you to consider such a position?’, 22.6% answered a change in employment package, 22.6% a change in family commitments, 16.6% too subspecialized, and 7.1% could possibly consider a locum or exchange in the future. Conclusions: Specialist positions, such as the advertised position, are well known, but remain unfilled because they are considered unsustainable. However, the response to hypothetical creative employment models suggests this could be changed, provided specialist training (e.g. paediatric training) is kept general and the younger consultant is given consideration.