bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term outcome of autoimmune hepatitis in children
Authors: Saadah Omar I , Smith Arnold L , Hardikar Winita 
Published: March 2003

AbstractBackground and Aim:Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology, which usually progresses to cirrhosis if not diagnosed and treated promptly. Data on long‐term follow up in children with AIH are scant. The aim of this study is to assess the long‐term outcome of autoimmune hepatitis in children with respect to clinical and laboratory features at presentation.Methods:Data were extracted from the medical records of patients presenting over a 28‐year period (1972–2000) to the Royal Children’s Hospital, Melbourne, Australia. Additional information was obtained by interviewing patients, and their current physicians. Of the 30 patients (22 females, mean age 9 years) identified, 18 had type I, three had type II, four had autoimmune–polyendocrinopathy syndrome type 1, one had infantile giant‐cell hepatitis associated with Coomb’s‐positive hemolytic anemia, and four were seronegative (antinuclear antibody (ANA), smooth muscle antibody (SMA) and liver–kidney microsomal antibody (LKM)).Results:Clinical features at presentation included hepatomegaly (86%), jaundice (66%) and splenomegaly (50%). Initial investigations revealed a median serum bilirubin level of 55 μmol/L (range 6–425), median aspartate aminotransferase level of 678 IU (range 70–2548), and abnormal clotting in 33% of patients. Liver biopsies were performed on all patients at presentation and 11 showed cirrhosis (36%). The mean follow‐up period was 10.0 ± 7.8 years with 43% being followed for > 10 years. Only two patients died and one required transplantation. Fourteen (50%) patients continue to be on low dose prednisolone with azathioprine, two (7%) are on prednisolone alone, and six (21%) are on no therapy. When the cirrhotic and non‐cirrhotic patients were compared, the albumin level at presentation was significantly lower in the cirrhotic group (P = 0.01). Of the patients who were cirrhotic at presentation, six (54%) remain compensated with a mean follow‐up period of 8 years. All 24 patients currently under follow up are engaged in age‐appropriate activities including school, part‐ or full‐time work.Conclusion:Autoimmune hepatitis has a favorable long‐term outcome with a transplant‐free survival rate of 90% over a mean period of 10.0 ± 7.8 years (range: 0.5–23), and a normal or near‐normal lifestyle irrespective of presenting clinical, laboratory or histological features.
Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis
Authors: Adachi Kyoichi , Fujishiro Hirofumi , Katsube Tomoko , Yuki Mika , Ono Masahiro , Kawamura Akira , Rumi Mohammad Azharul Karim , Watanabe Makoto , Kinoshita Yoshikazu 
Published: March 2003

AbstractBackground and Aims:Nocturnal gastric acid breakthrough (NAB) is defined as an intragastric pH < 4.0 lasting more than 1 h during the night in patients taking a proton pump inhibitor (PPI). Gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal acid reflux accompanied by NAB are thought to be refractory to PPI treatment. The aim of this study was to endoscopically identify the patients with predominant nocturnal gastroesophageal acid reflux.Methods:The subjects were 37 patients with erosive reflux esophagitis (Los Angeles classification (LA) grade A, 12; B, 10; C, eight; and D, seven cases) and a control group of 20 patients without esophagitis. The results of ambulatory 24 h gastric and esophageal pH monitoring were compared among different grades of esophagitis.Results:Gastroesophageal reflux during 24 h in patients with high‐grade esophagitis was more frequent than for patients with low‐grade esophagitis or no esophagitis. Although the length of esophageal acid exposure (percentage time with pH < 4.0) in patients with grade A or without esophagitis was longer in the daytime, that in patients with grades C and D was longer during the night. The reason for the delayed nocturnal acid exposure was the longer nocturnal acid clearance in high‐grade reflux esophagitis.Conclusions:Nocturnal exposure of the esophagus to acid occurs frequently in patients with LA grades C and D esophagitis. Thus, the existence of NAB with resulting nocturnal acid reflux should be considered when the patient with high‐grade esophagitis shows resistance to PPI treatment.
Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease
Authors: Tanaka Masanori , Saito Hiroshi , Kusumi Tomomi , Fukuda Shinsaku , Shimoyama Tadashi , Sasaki Yoshihiro , Suto Koji , Munakata Akihiro , Kudo Hajime 
Published: March 2003

AbstractBackground and Aim: Colorectal Paneth cell metaplasia (PCM) is known to be a sign of idiopathic inflammatory bowel disease (IBD), although its distribution and histogenesis are not fully understood. Objectives of this research were to investigate the spatial distribution of PCM in IBD and other forms of colitis (non‐IBD), and to find stimuli causing PCM.Methods: We studied multiple biopsy specimens from 181 patients with ulcerative colitis (UC), 159 with Crohn's disease (CD), 448 with non‐IBD, and 78 normal controls. Paneth cell metaplasia frequency, at each colorectal site, was evaluated to find possible differences among diseases, phases of activity, and extents of disease.Results: In non‐IBD and controls, PCM was rarely (0–1.9%) seen at distal sites, but frequently (up to 48.7%) found at the ascending colon and cecum (P < 0.001). Paneth cell metaplasia frequency was significantly higher in IBD than in non‐IBD patients and controls at distal sites (P < 0.001), but did not differ significantly between UC and CD, or among active, resolving, and quiescent phases. In UC, proctitis and left‐sided colitis rarely displayed PCM at unaffected sites. Multiple logistic regression analysis revealed that PCM was positively associated with crypt distortion and mononuclear cell infiltration (P < 0.005), but negatively or not significantly associated with crypt atrophy, mucin depletion, acute inflammation, or phase of activity.Conclusions: Paneth cell metaplasia is a non‐specific phenomenon in the proximal colon, but distal PCM, which occurs exclusively in affected mucosa, is a useful marker indicating IBD, even in the inactive phase. Regression analysis suggests that repair and regeneration may be the most potent stimuli causing PCM.
Higher seroprevalence of Helicobacter pylori infection in Korean adolescent athletes compared to age‐ and sex‐matched non‐athletes
Authors: CHOE YON HO , HWANG TAE SOOK , HONG YUN CHUL 
Published: March 2003

AbstractBackground Poor living conditions, such as overcrowding and bed‐sharing, are reported to be significant risk factors for Helicobacter pylori infection throughout childhood. We investigated the prevalence of H. pylori infection in Korean athletes who are obliged to live together in training camps for more than 6 months in a year.Methods Blood sampling and surveying through questionnaire were performed on 440 students from a regular high school (228 boys and 212 girls) and 220 athletes (148 boys and 72 girls) of a physical education high school. We measured serum immunoglobulin G antibody (IgG Ab) to H. pylori in order to compare the prevalence of H. pylori infection between normal adolescents and athletes. In addition, we conducted a nutritional analysis and questionnaire survey for socioeconomic status in order to compare other risk factors that might influence H. pylori infection between groups.Results The prevalence of H. pylori infection in athletes (43.2%) was higher than that in the controls (22.7%). No significant differences in the nutritional factors or socioeconomic status, such as Hollingshead index, type of house, number of siblings, and crowding index, were found between the groups. Multivariate analysis showed that crowding and the difference in school type were the significant predictors of H. pylori seropositivity after controlling for dietary and socioeconomic factors.Conclusion The seroprevalence of H. pylori infection was higher in adolescent athletes than in age‐ and sex‐matched regular students. Further prospective study is needed to confirm the observation.
Serum gamma‐interferon‐inducing factor (IL‐18) and IL‐10 levels in patients with acute hepatitis and fulminant hepatic failure
Authors: YUMOTO EIICHIRO , HIGASHI TOSHIHIRO , NOUSO KAZUHIRO , NAKATSUKASA HARUSHIGE , FUJIWARA KEISHI , HANAFUSA TADASHI , YUMOTO YASUHIRO , TANIMOTO TADAO , KURIMOTO MASASHI , TANAKA NORIAKI , TSUJI TAKAO 
Published: March 2003

AbstractBackground and Aims: The aim was to determine the role of T‐helper (Th)1/Th2 cytokine responses in the clinical outcome of patients with acute liver injury.Methods: The serum levels of the cytokines, interleukin (IL)‐18, gamma‐interferon (IFN‐γ), IL‐10 and IL‐4 were measured in 20 fulminant hepatic failure (FHF), 18 acute hepatitis (AH), 30 chronic viral hepatitis and 20 liver cirrhosis (LC) patients. Thirteen cases were from the intensive care unit (ICU) and there were 21 healthy volunteers. Immunohistochemical staining of liver biopsies for IL‐18 expression was also performed.Results: Serum IL‐18 levels in patients with FHF were significantly
more elevated than in patients with other liver diseases, ICU cases and healthy volunteers.
Furthermore, serum IFN‐γ levels in patients with FHF were also significantly
higher than in patients with chronic viral hepatitis, LC and healthy volunteers.
We found a positive correlation between the levels of IL‐18 and IFN‐γ. However,
no relationship was observed between these and clinical outcome. In immunohistochemical
staining, CD68+ macrophage cells and IL‐18‐positive cells were observed in portal
zones. Elevated serum IL‐10 levels were restricted to patients presenting with FHF,
and were significantly higher in surviving cases (P < 0.01). Furthermore,
serum IL‐10 levels, but not IL‐4 levels, were inversely correlated with serum total
bilirubin concentrations (P = 0.045) and the death rate (p) outlined in Japan
(P = 0.030).Conclusion: These results suggest that IL‐18 and IFN‐γ are involved in the pathogenesis of acute hepatic injury in humans, and that, in particular, elevated serum levels of IL‐10 may be predictive of improved outcomes for these patients.© 2002 Blackwell Science Asia Pty Ltd
A survey of Australian general practice management of hepatitis C‐infected patients from non‐English‐speaking backgrounds
Authors: DEV ANOUK , SIEVERT WILLIAM 
Published: March 2003

AbstractBackground: Australia receives many migrants from countries with a high prevalence of hepatitis C infection. General practitioners, who are often the first health professionals consulted, need to be aware of risk factors and complications associated with hepatitis C in this group.Methods: Four hundred and forty‐seven general practitioners, obtained from registries at two Melbourne teaching hospitals serving large non‐English‐speaking migrant populations, were sent a questionnaire. Two hundred and forty‐one returned a completed questionnaire. The survey attempted to assess knowledge of risk factors, complications, currently recommended antiviral therapy, referral practice to specialists and difficulties encountered by practitioners and patients in accessing information about HCV.Results: Sexual and vertical transmission were listed as more common risk factors than iatrogenic causes or injecting drug use. Most respondents interpreted basic diagnostic tests correctly but there was a range of estimates regarding progression to cirrhosis and hepatocellular carcinoma with many seriously overestimating these aspects of natural history. Interferon and ribavirin were commonly listed as optimal therapy, but both interferon monotherapy and lamivudine, a treatment for hepatitis B, were stated as optimal therapy by 25% of respondents. Considerable frustration was expressed regarding access to reliable information about treatment outcomes and to linguistically and culturally appropriate patient information.Conclusion: The wide response range regarding modes of acquisition of HCV in patients from non‐English‐speaking backgrounds, rates of progression to cirrhosis and hepatocellular carcinoma and optimal antiviral therapy suggests a need to improve provision of appropriate educational resources that will facilitate general practice management of a common and important public health problem.© 2002 Blackwell Science Asia Pty Ltd
Natural history of hepatocellular carcinoma including fibrolamellar and hepato‐cholangiocarcinoma variants
Authors: Okuda Kunio 
Published: March 2003

Abstract  The natural history of hepatocellular carcinoma (HCC) varies greatly with the global region, because the carcinogenic factors are not the same among countries. Besides the clinicopathological factors such as tumor characteristics, sex, and age, background liver disease is a major determinant of prognosis. Hepatocellular carcinoma, mainly associated with chemical carcinogens such as aflatoxin, does not have severe background cirrhosis, and grows quickly, whereas HCC developing in association with a virus in a cirrhotic liver generally grows more slowly, and the severity of cirrhosis is the major prognostic factor. The median survival of untreated sub‐Saharan African patients is less than 1 month from diagnosis, contrasted by an average survival of 4 months in virus‐induced HCC associated with cirrhosis. Tumor characteristics, such as size, number, and growth speed, which vary considerably from case to case, affect the prognosis. Vascular (portal) invasion portends a poor prognosis, and α‐fetoprotein levels also correlate with prognosis. Several distinct clinical types of HCC occur, namely diffuse‐type HCC caused by rapid portal spread of cancer cells, febrile‐type caused by poorly differentiated sarcomatoid cancer cells, and cholestatic HCC caused by intraductal invasion; all have a short survival. There are several histological variant forms: combined hepato‐cholangiocarcinoma behaves like HCC, with a poorer prognosis because of more frequent lymph node metastases; fibromellar carcinoma, which is relatively common in young Caucasian adults, has a good prognosis if diagnosed early, permitting resection; and cholangiolocellular carcinoma, which derives from the canalicular epithelium, is indistinguishable from HCC, with a similar prognosis.© 2002 Blackwell Publishing Asia Pty Ltd
Clinicopathologic features of patients with hepatocellular carcinoma seropositive for α‐fetoprotein‐L3 and seronegative for des‐γ‐carboxy prothrombin in comparison with those seropositive for des‐γ‐carboxy prothrombin alone
Authors: OKUDA HIROAKI , NAKANISHI TOSHIMI , TAKATSU KAZUKO , SAITO AKIKO , HAYASHI NAOAKI , YAMAMOTO MASAKAZU , TAKASAKI KEN , NAKANO MASAYUKI 
Published: March 2003

Abstract
Background
: There has been no study of the clinicopathologic features of patients with hepatocellular carcinoma (HCC) who are seropositive for lectin‐reactive α‐fetoprotein (AFP‐L3) alone, or seropositive for AFP‐L3 and seronegative for des‐γ‐carboxy prothrombin (DCP) in comparison with those who are seropositive for DCP alone. Thus, the present comparative study was performed.
Methods
: The clinicopathologic features of HCC patients with either one or two tumors who underwent a hepatectomy (n = 88) were compared among the following five groups according to the seropositivity of AFP, AFP‐L3 and DCP: (i) group A, seropositive for AFP above 100 ng/mL, AFP‐L3 above 15% and DCP above 100 mAU/mL; (ii) group B, seropositive for AFP‐L3 and seronegative for DCP below 40 mAU/mL; (iii) group C, seronegative for AFP below 20 ng/mL, AFP‐L3 below 15% and seropositive for DCP; (iv) group D, seropositive for AFP and seronegative for AFP‐L3 and DCP; and (v) group E, seronegative for AFP, AFP‐L3 and DCP.
Results
: Group B patients showed a higher incidence of infiltrative‐type HCC with an irregular margin (P < 0.05) and a higher frequency of poorly differentiated HCC (P < 0.01) compared with group C patients. Group A patients had larger tumors and more massive‐type tumors than group B patients. Our HCC cases showed that advanced clinicopathologic features were demonstrated in the order of group B, group C and group D. Group A and B patients and group D and E patients showed similar characteristics.
Conclusions
: Hepatocellular carcinoma patients who were seropositive for AFP‐L3 and seronegative for DCP demonstrated clinicopathologic features of more advanced HCC compared with those who were seropositive for DCP alone.© 2002 Blackwell Publishing Asia Pty Ltd
Treatment of non‐resectable hepatocellular carcinoma with autologous tumor‐pulsed dendritic cells
Authors: Ladhams Andrew , Schmidt Chris , Sing Garwin , Butterworth Lesley , Fielding George , Tesar Paul , Strong Russell , Leggett Barbara , Powell Lawrie , Maddern Guy , Ellem Kay , Cooksley Graham 
Published: March 2003

Abstract Background: The response of hepatocellular carcinoma (HCC) to therapy is often disappointing and new modalities of treatment are clearly needed. Active immunotherapy based on the injection of autologous dendritic cells (DC) co‐cultured ex vivo with tumor antigens has been used in pilot studies in various malignancies such as melanoma and lymphoma with encouraging results.Methods: In the present paper, the preparation and exposure of patient DC to autologous HCC antigens and re‐injection in an attempt to elicit antitumor immune responses are described.Results: Therapy was given to two patients, one with hepatitis C and one with hepatitis B, who had large, multiple HCC and for whom no other therapy was available. No significant side‐effects were observed. The clinical course was unchanged in one patient, who died a few months later. The other patient, whose initial prognosis was considered poor, is still alive and well more than 3 years later with evidence of slowing of tumor growth based on organ imaging.Conclusions: It is concluded that HCC may be a malignancy worthy of DC trials and sufficient details in the present paper are given for the protocol to be copied or modified.
[13C]‐Urea breath test without prior fasting and without test meal is accurate for the detection of Helicobacter pylori infection in Chinese
Authors: Ng Fook Hong , Lai Kam Chuen , Wong Benjamin Chun Yu , Wong Wai Man , Wong Siu Yin , Chow Kai Chiu , Yuen Siu Tsan , Leung Suet Yi , Lam Shiu Kum 
Published: March 2003

Abstract Background and Aim: Conventional [13C]‐urea breath test ([13C]‐UBT) requires prior fasting and a test meal, which theoretically improves the accuracy of the test. However, recent studies have suggested that prior fasting and test meal may not be essential. We aimed to determine the accuracy of a new [13C]‐UBT protocol without fasting in Chinese.Methods: Dyspeptic patients referred for upper endoscopy were recruited. The gold standard for Helicobacter pylori infection was the combination of Campylobacter‐like organism (CLO) test and histology. Group I (n
= 213) patients underwent [13C]‐UBT with prior fasting and with citrate acid test meal. Group II (n
= 123) patients underwent [13C]‐UBT without prior fasting but with test meal. Group III (n
= 90) patients underwent [13C]‐UBT without prior fasting and without test meal.Results: The highest accuracy for groups I, II and III was 96.7, 95.1 and 95.5% using a cut‐off value of 5.0, 5.5 and 3.5, respectively. The sensitivities and specificities were 97.4 and 95.8% in group I, 93.3 and 96.8% in group II, and 96.5 and 93.9% in group III, respectively.Conclusion: The [13C]‐UBT protocols without prior fasting and either with or without test meal produce highly accurate and reliable results in the Chinese population.
Clinical profile of primary sclerosing cholangitis in Singapore
Authors: Ang Tiing Leong , Fock Kwong Ming , Ng Tay Meng , Teo Eng Kiong , Chua Tju Siang , Tan Jessica Yi‐Lyn 
Published: March 2003

Abstract Background and Aim: Primary sclerosing cholangitis (PSC) is a rare chronic disease in Singapore and its epidemiological profile has not been described previously. The present study aimed to define the demographic and clinical profile of patients with PSC in Singapore.Methods: The case records of patients with PSC seen at Changi General Hospital were analyzed in terms of demographic profile, clinical presentation, clinical course, treatment and complications.Results: Ten cases of PSC were diagnosed over a 10‐year period. The male:female ratio was 9:1. The median age of diagnosis was 49.5 years (mean: 50.9 years; range: 35–63 years). With regards to clinical presentation, seven patients had hepatobiliary sepsis, two patients had asymptomatic liver biochemistry abnormalities while one patient had cholestatic jaundice. Prevalence rate of perinuclear antineutrophil cytoplasmic antibody (pANCA) was 20%. Symptomatic inflammatory bowel disease (IBD) was diagnosed in 20% of PSC cases. Eight patients (80%) had intrahepatic ductal involvement while two patients (20%) had combined intrahepatic and extrahepatic ductal involvement on endoscopic retrograde cholangiopancreatography (ERCP). The prevalence rate of recurrent cholangitis was 30% while that of recurrent liver abscess, cirrhosis and common bile duct stricture were all 10%. The mean duration of follow up was 6.6 years with one death from liver failure.Conclusion: The clinical profile of patients with PSC in Singapore appears to differ with other published data, with a greater number presenting with hepatobiliary sepsis and less frequent association with IBD and pANCA. It is hypothesized that this may be related to differences in environmental triggers and genetic susceptibility.
Pathology of fundic varices of the stomach and rupture
Authors: Arakawa Masahiro , Masuzaki Takao , Okuda Kunio 
Published: March 2003

AbstractBackground and Aim: Gastric varices, the rupture of which can be a fatal complication of portal hypertension, have not been well documented histopathologically. While cardiac varices develop in continuity with esophageal varices, fundic varices develop independently, having characteristic pathophysiology. Elucidation of the angioarchitecture of fundic varices will facilitate future improvement of treatment.Methods: Twelve stomachs with fundic varices, either resected or autopsied, were examined by injecting a barium‐gelatin solution into the vein that was forming varices, soft X‐rayed for the study of the vessel course, and then the stomach made into transparent preparations for stereoscopic study. Five fundic varices with a recognizable rupture site were studied histologically.Results: Fundic varices could be classified into two types: Type I, single vein forming the supplying vessel, varix and draining vessel without changing caliber (eight cases) or plural veins supplying the varix (one case) and; Type II, many branching vessels existing beside the main supplying and draining vessels (three cases). Fundic varices exist in the submucosa with no enlarged vein in the lamina propria, and rupture occurs through the portion of the varix that protrudes into the stomach lumen penetrating the muscularis mucosae and lamina propria.Conclusions: Fundic varices form with the supplying vessel, mostly singular, and the draining vessel is frequently a gastrorenal collateral. Fundic varices form in the submucosa, unlike esophageal varices, and perforate through the overlying muscularis mucosae and lamina propria.