Showing papers in "Journal of Gastroenterology and Hepatology in 1987"

The significance of cell death by apoptosis in hepatobiliary disease

Abstract: Keywords: acidophilic body; apoptosis; cell death; Councilman body; hepatitis; piecemeal necrosis.

Racial differences in peptic ulcer frequency in Singapore

Abstract: Several hospital series of peptic ulcer patients have suggested that ulcer prevalence may be different in the different races in Singapore. However, such studies may be biased because different races use hospital services differently and also because hospital catchment populations are difficult to define. In the present study the racial composition of a consecutive series of 1248 peptic ulcer patients seen in two medical units of a general hospital was compared to that of 2023 general medical patients attending the same units. For both sexes, the racial structure of the gastric ulcer as well as the duodenal ulcer patients was significantly different from that of the general medical group. There was an excess of Chinese patients of both sexes with gastric ulcer and duodenal ulcer. In contrast, the numbers of male Malay gastric ulcer, male Malay duodenal ulcer, female Malay duodenal ulcer as well as Indian gastric ulcer patients of both sexes were fewer than expected. These results cannot be accounted for by racial differences in either health-seeking behaviour or analgesic and tobacco usage. These observations confirm the probable occurrence of racial differences in peptic ulcer frequency in Singapore.

Elevation of gastric pH heals peptic oesophagitis ‐ A role for omeprazole

Abstract: The aim of this study was to investigate the hypothesis that the prolonged and substantial elevation of gastric pH which can be achieved with the antisecretory agent omeprazole will result in healing of peptic oesophagitis. Eight patients with erosive or ulcerative peptic oesophagitis were treated with omeprazole (30 mg daily) for 8 weeks. Complete healing occurred in seven patients after 8 weeks of omeprazole therapy. Only a small area of residual ulceration persisted in one unhealed patient. Heartburn resolved within the first 2 weeks of therapy in all but one patient. Specific food intolerances also were eliminated in most cases. Post-prandial oesophageal pH monitoring during omeprazole administration showed abolition of acid reflux episodes (pH < 4). This effect appeared to be due solely to the antisecretory effect of omeprazole, since motility measurements demonstrated a continued high frequency of reflux while concurrent gastric pH monitoring showed sustained elevation of gastric pH above 4. These results support the hypothesis that a prolonged and potent inhibition of gastric acid secretion renders refluxed gastric juice sufficiently innocuous to allow healing of severe peptic oesophagitis.

Acute sporadic non‐A, non‐B viral hepatitis of adults in India—Epidemiological and immunological studies

Abstract: On the basis of tests for specific IgM class antibodies in the serum, infections by hepatitis A virus, hepatitis B virus and hepatitis non-A, non-B virus accounted for 7%, 37.8% and 54.2% respectively of 286 cases of acute sporadic viral hepatitis in adults from three different regions of India. Epstein-Barr virus and cytomegalo virus were insignificant (0.5-1%) aetiological agents. Approximately one-quarter of all non-A, non-B (NANB) cases were additionally HBsAg carriers; there were significant differences in regional frequencies. NANB hepatitis commonly affected individuals in the mid-fourth decade and occurred throughout the year with small peaks in different seasons. No antigen-antibody reaction could be demonstrated in various immunological tests including radioimmunobinding using acute and convalescent phase sera. Neither were virus-like particles visualized in acute phase sera on electron and immuno-electron microscopy. However, rhesus monkeys inoculated with acute phase serum from a case of NANB hepatitis developed distinct hepatocellular changes at 43-55 days after inoculation, which had some features of similarity with experimental NANB hepatitis of other simian species. Sporadic NANB hepatitis is a major health problem throughout India and intensive study is needed on its epidemiology and aetiology.

Delta-agent infection in Taiwan

Abstract: Based on observations of a limited number of patients, delta (δ) infection has been reported to be infrequent in Taiwan. To further evaluate the role of δ-infection in patients with hepatitis B virus (HBV) infection, serum samples of 493 subjects with acute and chronic HBV infections collected in 1976–85 were studied for anti-δ by radioimmunoassay. Intrahepatic δ-antigen was also studied by immunofluorescence in 12 anti-δ-positive patients. The overall prevalence of δ-infection was 4.7%, consistent with previous studies. δ-Infection had an even yearly distribution in the last decade. However, there were four groups with significantly higher frequencies: (i) 24% of 41 anti-HBe-positive patients with chronic active hepatitis (CAH); (ii) 21% of 14 HBsAg carriers with prominent lobular hepatitis; (iii) two of three HBsAg carriers with intravenous drug abuse; and (iv) two of seven with fulminant hepatitis. On the other hand, δ-infection was uncommon in patients with chronic persistent hepatitis, cirrhosis, hepatocellular carcinoma, classical type B hepatitis, submassive necrosis and asymptomatic HBsAg carriers. δ-Antigen was found in only two patients with CAH; one progressed to cirrhosis, and the other had disease regression on follow-up. Overall, at least half of the δ-superinfected HBsAg-positive patients had a non-progressive course on follow-up. It was concluded that δ-agent was introduced to Taiwan before 1976. Although it has played a role in some clinical settings of HBV infections, it is generally infrequent in Taiwan. The δ-superinfection apparent in half the patients studied seems to have a non-progressive course.

Intestinal absorption, metabolism and effects of bacterial chemotactic peptides in rat intestine

Abstract: N-formylated chemotactic peptides are produced by intestinal bacteria in vitro and Can be detected in intestinal luminal fluids. The healthy intestine must have mechanisms for preventing absorption of such peptides which can induce an inflammatory response when introduced systemically. Synthetic formyl-methionyl-leucyl-phenylalanine (F-met-leu-3H-phe) has been used as a model bacterial chemotactic peptide to investigate intestinal absorption and metabolism of such peptides in the rat. Disappearance of tritium-activity was rapid from jejunal and ileal loops and substantial hydrolysis of peptide occurred with only labelled metabolites appearing in portal blood. Less absorption and less metabolism occurred in the colon. Degradation of F-met-leu-phe was due to a mucosal carboxypeptidase and was inhibited by benzylsuccinate, a potent inhibitor of the enzyme. In the presence of inhibitor, luminal disappearance from ileal loops was abolished and F-met-leu-3H-phe was not detected in portal blood indicating that healthy gut mucosa is ‘impermeable’ to intact peptide. The intestinal ‘barrier’ preventing mucosal penetration and the inflammatory effects of luminal bacterial peptides have two components: restricted mucosal permeability and a carboxypeptidase capable of hydrolysing such peptides with loss of their bioactivity.

Expression of urokinase‐type plasminogen activator in the mucosal lesions of inflammatory bowel disease

Abstract: The expression of plasminogen activators was analysed in mucosal homogenates from inflammatory bowel disease patients to determine whether the urokinase-type (u-PA) is implicated in the pathogenesis of mucosal tissue injury. Homogenates of mucosal biopsy tissue from ulcerative colitis, Crohn's disease, infectious colitis and normal control patients were subjected to polyacrylamide gel electrophoresis. The types of plasminogen activator present were detected by zones of lysis in a fibrin-agarose gel overlay. All the tissues studied displayed tissue plasminogen activator activity (t-PA). In ulcerative colitis, 18 of the 19 diseased colon biopsies, but none of six biopsies from uninvolved areas of the same colon, showed u-PA activity. Similar results were found in 12 Crohn's disease patients. Biopsies from the infectious colitis group and from radiation colitis patients also showed both u-PA and t-PA activity. The age, sex, duration of disease, and presence and type of treatment did not affect u-PA expression in the inflamed mucosa. The results suggest that u-PA may be implicated in the mediation of tissue injury in the inflamed intestinal mucosa.

Absence of transmission of hepatitis B by fibreoptic upper gastrointestinal endoscopy

Abstract: A prospective survey on all patients undergoing fibreoptic upper gastrointestinal endoscopy during a 3 month period was conducted to determine the risk of transmission of hepatitis B. Four hundred and sixty-eight patients underwent 637 endoscopy examinations in 47 endoscopy sessions. Of these, 15% were positive for hepatitis B surface antigen (HBsAg), 58.9% anti-HBs/anti-HBc-positive and 26.1% negative for hepatitis B virus (HBV) markers on entry into the study. One hundred and eleven patients with no HBV markers underwent endoscopy during the same sessions as 69 HBsAg-positive patients. Forty of these patients were endoscoped subsequent to HBeAg-positive patients on at least one occasion. None of the HBV-negative patients seroconverted to HBsAg or anti-HBs/anti-HBc at the end of 6 months. It was demonstrated that with a standard cleaning procedure there was no evidence of endoscopic transmission of HBV infection even in an endemic area.

Pathogenetic role of Campylobacter pyloridis in gastric ulcer

Abstract: Recent reports of the occurrence of Campylobacter pyloridis in the stomach of patients with gastric ulcer have revived interest in the possible aetiological role of bacteria in this condition. To study the pathogenetic role of C. pyloridis in gastric ulcer, endoscopic biopsies, at least four from antrum, four from fundus and four, where appropriate, from the ulcer site, were taken from 28 non-ulcer controls and 67 patients with gastric ulcer before and after complete healing of ulcer, following treatment with either enprostil or cimetidine for up to 8 weeks. The activity of gastritis as assessed by the degree of polymorph infiltration was graded blindly, by two independent pathologists, as nil, mild, moderate or severe. The presence of C. pyloridis was determined by smear and culture, and by Warthin Starry stain, and the bacterial density after staining was scored. The occurrence of C. pyloridis in the gastric antrum was not significantly different in gastric ulcer than in controls but was significantly (P < 0.005) more frequent in gastritic than in non-gastritic mucosa. With gastric ulcer healing the activity of antral gastritis improved significantly (P < 0.05). Despite ulcer healing and improvement of gastritis, the frequency of occurrence and the density of C. pyloridis remained unchanged. It seems that C. pyloridis occurs frequently in gastritic mucosa, and does not affect the healing of gastric ulcer or improvement of gastritis, suggesting that it is unlikely to play a major pathogenetic role.

Hepatobiliary excretion and enterohepatic circulation of bacterial chemotactic peptide (FMLP) in the rat

Abstract: N-formyl methionyl leucyl 3H-phenylalanine was used as a model bacterial chemotactic peptide to study the systemic metabolism and excretory pathways for such peptides in the rat. After intravenous bolus infusion, the peptide was rapidly cleared from the systemic circulation with a mean of 22% of the dose being excreted in bile over 2 h. In bile, 53% of radioactivity existed as intact peptide, the remainder was its degradation product, 3H-phenylalanine. No intact peptide was detected in urine. While previous studies have shown no significant absorption of F-met-leu-phe from normal rat intestine, in the current studies ileal loop infusions of F-met-leu-phe in hyperosmolar solution, to increase gut permeability, resulted in absorption of intact peptide which was recovered in bile. These studies show that bile is a major pathway for excretion of bacterial chemotactic peptide in the rat and confirm the potential for an enterohepatic circulation of peptides from the gut lumen under conditions of increased intestinal mucosal permeability.

Percutaneous transhepatic catheterization of the portal venous system

Abstract: Percutaneous catheterization of the portal venous system can be performed by puncture of the liver, by recanalization of the umbilical vein and through a transjugular-transhepatic route (via the jugular vein, vena cava and hepatic vein and then through the liver parenchyma) (Fig. 10.1). Transumbilical catheterization of the portal vein is a surgical procedure which at the present time is used only occasionally. The transjugular-transhepatic catheterization can be carried out when percutaneous liver puncture is contraindicated because of coagulopathy, but selective catheterization of the extrahepatic portal venous system is technically difficult, and experience in the method is still limited.

An evaluation of the phenomenon of cytoprotection using quantitative histological criteria

Abstract: The concept of ‘cytoprotection’ is derived from observations that exogenous prostaglandins protect the gastric mucosa against injurious agents at doses insufficient to inhibit acid secretion Measurements of the extent of cytoprotection generally rely on inspection of the open stomach for assessment of the extent of damage Recent studies indicate that such macroscopic criteria are inaccurate This study reports the development of quantitative histological techniques that enable valid studies of cytoprotection Using a rat model of cytoprotection, injury was induced with 1 ml of absolute ethanol Cytoprotection was induced with 25 μg prostaglandin E2 (PG) intragastrically 15 or 30 min prior to ethanol exposure The area of macroscopic damage was measured with a computer-based digitizer Semi-thin plastic sections of eight separate areas of the stomach were examined histologically and the length and depth of damage were measured using the digitizer Surface area and volume of mucosal damage were calculated from these values On macroscopic assessment after exposure to ethanol for 15 min, 446% of the surface appeared damaged After pretreatment with PG the extent of ethanol damage appeared to be reduced On microscopic assessment, however, the extent of damage was much greater with 945% of the surface damaged after ethanol alone and 737% surface damaged after pretreatment with PG Thus, macroscopic assessment clearly underestimates the extent of damage However, these data do indicate that PG protects the surface epithelium from the effects of ethanol A much clearer demonstration of protection is evident from measurement of the volume of mucosa damaged After ethanol alone, 315% of the mucosal volume was damaged compared with 38% when pretreatment by PG was given When measurements were performed after exposure to ethanol for 30 min, significantly less surface area damage was present in the ethanol group All other measurements were not different from the 15 min results This study confirms the existence of cytoprotection, but indicates that macroscopic assessment underestimates the extent of damage, particularly in the cytoprotected stomach Techniques for accurate microscopic measurement of the extent of damage are described which permit comparison between different cytoprotective agents

The effects of cisapride on gastric and oesophageal emptying in dystrophia myotonica

Abstract: The effects of cisapride on gastric emptying, oesophageal emptying, and gastrointestinal symptoms were evaluated in 10 patients with dystrophia myotonica who had delayed gastric emptying of the solid and/or liquid component of a meal. A double isotope technique was used to measure gastric emptying and oesophageal emptying was measured as the time taken for a bolus of the solid meal to enter the stomach. Gastrointestinal symptoms were assessed by a questionnaire. Gastric and oesophageal emptying and gastrointestinal symptoms were measured before and when each subject had taken cisapride (10 mg, q.i.d., p.o.) for 4 weeks. Cisapride improved solid gastric emptying, and there was a non-significant trend for improved liquid emptying. Cisapride had no effect on oesophageal emptying. Upper gastrointestinal symptoms were less after cisapride and there was an increased frequency of bowel actions. No side effects were reported. These results indicate that gastroparesis is a treatable cause of morbidity in dystrophia myotonica.

Hepatitis B e antigen and its antibody in chronic type B hepatitis

Abstract: Keywords: anti-HBe; HBeAg; HBV DNA; chronic HBV infection; chronic type B hepatitis; cirrhosis; HBsAg carriers; hepatocellular carcinoma.

Analysis of bilirubin conjugates in human bile by column liquid chromatography—Changes in their composition in hepatobiliary diseases

Abstract: Bilirubin in human bile was analysed by high performance liquid chromatography (HPLC), and seven peaks were identifiable. There was no difference in the proportion of bilirubin between the B bile and C bile from healthy humans obtained by the Meltzer-Lyon method. HPLC coupled with nuclear magnetic resonance spectroscopy on bilirubin after diazotization permitted differentiation between endovinyl and exovinyl conjugates of bilirubin. In patients with Gilbert's syndrome, type II Crigler-Najjar syndrome, and haemolytic anaemia, the proportion of bilirubin diglucuronide (BDG) in the C bile decreased, and that of bilirubin monoglucuronide (BMG) increased. In patients with type II Crigler-Najjar syndrome, marked elevations in BMG and bilirubin IXα and decreases in bilirubin monoglucuronide monoglucoside diester (BGG) and bilirubin monoglucuronide monoxyloside diester (BGX) were observed. In normal subjects and patients with unconjugated hyperbilirubinaemia, the diazobased indirect-reacting bilirubin levels in blood and the proportion of BMG in bile were in good correlation. In patients with acute hepatitis, chronic hepatitis, and liver cirrhosis, there was no difference in the bilirubin composition in bile as compared to normal subjects, except for slight elevations in BGG observed in patients with chronic hepatitis and liver cirrhosis. In gallbladder bile obtained from patients with cholelithiasis, bilirubin IXα increased, suggesting some deconjugation of BDG.

Drugs for portal hypertension

Abstract: Pharmacology of portal hypertension is a very active area. Several vasoactive agents are now known to reduce portal pressure (Fig. 1; Table 1) and, therefore, are potentially useful in the treatment of portal hypertension. These drugs act in different ways and seem to have several actions. In this review, only recent findings of haemodynamic studies are presented and the different mechanisms are discussed. Portal pressure depends on several factors: portal tributary blood flow, vascular tone in the portal territory and hepatic vascular resistance. Therefore, there are at least three types *\\ *,\",FlENGlc

Endoscopic manometry of the sphincter of Oddi

Abstract: Endoscopic manometry of the sphincter of Oddi is a new and invasive test which is currently being evaluated in patients with biliary-type pain, particularly after cholecystectomy, and idiopathic recurrent pancreatitis. Technical aspects of the test appear to have been clarified, but data are incomplete on the potential effect on manometric records of variables such as patient anxiety, prolonged endoscopy and the injection of radiological contrast material prior to the procedure. Despite these considerations, abnormal manometric records are frequent in patients with post-cholecystectomy pain and idiopathic recurrent pancreatitis, and minor abnormalities have been associated with choledocholithiasis. The term structural stenosis is currently being applied to those in whom the sphincter basal pressure is high while biliary dyskinesia describes a variety of manometric changes including rapid phasic contractions, an excess of waves oriented in a retrograde direction and an abnormal response to the intravenous infusion of cholecystokinin octapeptide. Reasons for the motility disorders remain unclear but may include histopathological changes in sphincter tissue, enteric nerve dysfunction, autonomic dysfunction, hormonal/metabolic changes and psychiatric disorders. Heterogeneity within the patient population needs to be carefully addressed in any prospective study of potential benefit from drugs or other procedures such as endoscopic sphincterotomy and operative sphincteroplasty.

Pattern of upper gastrointestinal haemorrhage in northern India—An endoscopic study of 316 patients

Abstract: Three hundred and sixteen patients with acute upper gastrointestinal haemorrhage were studied prospectively and consecutively. The most frequent cause was variceal bleeding due to portal hypertension (36%), followed by peptic ulceration (24%) and gastric erosions (19%). Variceal haemorrhage tended to be severe and had a high individual mortality rate. Associated acute mucosal lesions with portal hypertension were strikingly less frequent when compared with the experience from the West. Seven per cent of patients died of bleeding alone and an equal number of an associated systemic disorder or complication. Splenomegaly was present in all patients with a variceal haemorrhage due to non-cirrhotic portal hypertension. However, in patients with portal hypertension due to cirrhosis splenomegaly was present in 63%. Endoscopy altered the clinical diagnosis in 13.2% of patients. Based on previous experience oesophago-gastro-duodenal endoscopy has been a useful tool in the management of acute upper gastrointestinal haemorrhage.

Evaluation of the Crithidia assay to distinguish between auto-immune chronic active hepatitis and systemic lupus erythematosus

Abstract: The aim of this study was to determine if the Crithidia luciliae assay for auto‐antibodies to double‐stranded DNA, often positive in systemic lupus erythematosus, is always negative in auto‐immune chronic active hepatitis (CAH) as has recently been suggested. Twenty‐five patients were identified as having auto‐immune CAH. Mean duration of follow‐up was 10.5 years. Antinuclear antibodies were detected in 92%, smooth muscle antibodies in 76% and antimitochondrial antibodies in 16%. Antibodies to double‐stranded DNA were detected by the Crithidia assay in four patients (16%). Two of these patients had positive tests on only one occasion and no features of systemic lupus erythematosus. In the other two the assay was persistently positive. During follow‐up both developed arthritis and serositis but the liver lesion remained the dominant clinical feature. It was concluded that there is significant serological overlap between auto‐immune CAH and systemic lupus erythematosus making the Crithidia assay unreliable in distinguishing between them. Copyright

In vitro growth of epithelial cells from mucosa derived from different regions of the gastrointestinal tract

Abstract: Attempts have been made to culture the mucosa from various parts of the gastrointestinal tract. In this study, using an explant culture method, epithelial cells have been successfully cultured from all major regions of the gastrointestinal tract. The success rate, as judged by outgrowth of epithelial cells for at least 4 weeks, varied with the tissue studied with 19/50 colonic biopsies, 5/11 small intestinal biopsies, 9/12 stomach biopsies and 42/47 gallbladder biopsies yielding outgrowth of epithelial cells. Differentiation of the epithelial cells along the mucus cell pathway could be demonstrated on the monolayer cultures using Periodic acid Schiff or Alcian blue staining. Because the cultures were very heterogeneous and many morphological cell types were present in most cultures, differentiation along the other known differentiation pathways of the gastrointestinal mucosa, such as development of absorptive cells and endocrine cells, could not be excluded. The problem of bacterial contamination, which has hindered previous studies on tissue from these sites, was overcome by decontaminating the biopsy by soaking in dilute sodium hypochlorite (0.04%).

Historical hepatology: Ludwig van Beethoven

Abstract: Ludwig van Beethoven has maintained his eminent position as one of the world’s greatest musicians. His early achievements as composer and performer showed him to be extending the Viennese classical tradition that he hid inherited from Mozart and Haydn. From his success at combining tradition and personal expression, he came to be regarded as the dominant musical figure of the 19th century, and scarcely any significant composer since his time has escaped his influence or failed to acknowledge it. And yet Beethoven was a man plagued by chronic illness, a multisystem disease that spanned over 40 years. Many musical and medical historians have speculated on the effect produced on the main body of his music by the composer’s lifelong ill-health.’-4 While his deafness, which prevented him from hearing many of his most profound and sublime compositions, was his most celebrated handicap, Beethoven suffered from liver and intestinal disease which is of interest to the gastroenterologist, physician and pathologist. This article reviews the available evidence pertaining to the medical illness of Beethoven. MEDICAL HISTORY

Determination of cellular retinol‐binding protein in human hepatocellular and colorectal carcinomas by radioimmunoassay

Abstract: A study was conducted to determine the tissue levels of cellular retinol-binding protein (CRBP), serum retinol-binding protein (RBP) and retinoids in hepatocellular carcinoma (HCC) and in colorectal adenocarcinoma. CRBP, which has a molecular weight of 14 900 daltons and an isoelectric point of 4.9, was purified from human liver. An antihuman CRBP antibody was raised in the turkey and further purified by immunosorbent affinity chromatography on CRBP-coupled Sepharose column. A radioimmunoassay for CRBP using this antibody was established. RBP was measured by an enzyme immunoassay and retinoids were measured by high-performance liquid chromatography analysis. Retinol levels in liver tumours were significantly decreased compared with those in respective non-cancerous adjacent tissues. Retinyl ester levels in liver tumours were also significantly decreased compared with those in the adjacent tissues. CRBP levels in liver tumours were significantly decreased compared with those in the adjacent tissues, whereas no significant difference was observed in the CRBP level between the colon tumours and adjacent colon tissues. RBP levels in liver tumours were also significantly decreased compared with those in the adjacent tissues. The decreased CRBP levels in liver tumours may, at least in part, account for the local deficiency of retinol in HCC, whereas colon tumours may grow independently, regardless of retinol status.

Role of cholic acid in the dietary induction of cholesterol gall‐bladder stones in mice

Abstract: The diet of male Swiss mice was supplemented with cholesterol and different bile acids, or the plant sterol diosgenin, to determine the effect on cholesterol metabolism and gallstone formation. Cholic acid enhanced intestinal cholesterol absorption and markedly increased cholesterol levels in serum, liver and bile. In contrast, chenodeoxycholic acid, ursodeoxycholic acid and hyodeoxycholic acid inhibited the increase in cholesterol absorption and liver cholesterol content produced by a cholesterol-supplemented diet. Biliary cholesterol reached saturated levels in mice fed cholesterol and cholic acid or diosgenin, but gallstones were observed only in association with the cholic acid-containing diet. This diet also induced marked gall-bladder enlargement with mucus glycoprotein hypersecretion. These results indicate that both supersaturated bile and gall-bladder mucus production may be necessary for the development of gallstones in mice.

Alimentary tract tuberculosis. A continuing challenge to gastroenterologists—Report of 55 cases

Abstract: Although uncommon in developed countries gastrointestinal tuberculosis is an important treatable disease and the diagnosis is often difficult. Between November 1982 and November 1985 tuberculosis was diagnosed in 544 patients at the Armed Forces Hospital, Riyadh. Of these 55 (10.11%) had tuberculosis of the gastrointestinal tract confirmed by histology and/or microbiology, from material obtained during surgical exploration or endos-copy. Disease was located in the oesophagus and stomach (4), small bowel (18), large bowel (15), peritoneum (21) and liver (11). The proportion of alimentary tract tuberculosis found in this study is high when compared with other reports. The presentation, diagnosis and response to treatment of these 55 patients is described and the value of endoscopy in diagnosis is illustrated.

Hepatitis A and B in Australian Aboriginals living in an urban community

Abstract: A high prevalence of hepatitis B virus (HBV) infection is recognized in Australian Aboriginals, but epidemiological data on contemporary Aboriginal communities are limited This study investigated HBV infection in urban Aboriginals from Condobolin, New South Wales, Australia Sera from 236 Aboriginals and 125 Caucasians were screened by radio-immunoassay for hepatitis B surface and e antigens, antibodies to surface, e and core antigens (including IgM anti-HB core—EIA), and antibodies to hepatitis A virus (anti-HAV) Sera which were positive for HBsAg were tested for hepatitis B e antigen, HBV-DNA polymerase and HBV-DNA molecular hybridization More than half the Aboriginals tested (576%) had serological evidence of HBV infection (169% HBsAg) and 845% had anti-HAV There were no statistically significant differences between males and females for any marker The Caucasians had 72% HBV antibodies, no HBsAg and 320% anti-HAV Aboriginal children in their first decade had 360% HBsAg and the prevalence of this antigen fell to 42% in Aboriginals over 50 years of age The opposite age trend was found for antibodies which increased from 16% in children to a peak of 552% for adults aged 30–39 Endemic hepatitis B acquired early in life is evident in this Australian Aboriginal urban community Transmission may be vertical or horizontal or both Immunoprophylaxis with immune globulin and hepatitis B vaccine is recommended for neonates and seronegative individuals The 91% prevalence of anti-HAV in these Aboriginals aged 10–19 years is comparable to that of the developing world

The effects of a prostaglandin E1 analogue, misoprostol, on gastric mucosal blood volume index and haemoglobin oxygenation in humans

Abstract: A double-blind placebo-controlled parallel design study was conducted in 12 healthy male volunteers to examine the effects of misoprostol, a newly synthesized prostaglandin E1 analogue, on gastric mucosal haemodynamics in human. The indices of mucosal blood volume (expressed as ΔEr) and mucosal blood haemoglobin oxygenation (Hb-SO2) were measured at 20 locations in the stomach prior to and after administration of misoprostol or its placebo using reflectance spectrophotometry during endoscopy. It was found that after misoprostol administration, mucosal blood volume was increased by approximately 10–25% throughout the stomach without any significant change in mucosal blood Hb-SO2. Administration of placebo produced no significant change in these parameters. The results suggest that misoprostol has the potential to accelerate healing of gastric ulcers by increasing the gastric mucosal blood volume and oxygenation in addition to its gastric acid antisecretory activity.

The relationship between portal pressure and plasma albumin in the development of cirrhotic ascites

Abstract: Ascites develops as a result of avid renal sodium retention together with an imbalance of Starling's equilibrium at the level of the hepatic sinusoid and mesenteric capillary. This study aimed to examine the effect of the imbalance between portal pressure, measured as corrected wedged hepatic vein pressure (cWHVP) and plasma oncotic pressure, measured as plasma albumin on the development of cirrhotic ascites. Fifty-two patients with biopsy-proven alcoholic cirrhosis were studied on 72 separate occasions. The absence of ascites was determined by the combination of lack of signs of free intraperitoneal fluid and normal prothrombin time in patients not receiving diuretics. If signs of free intraperitoneal fluid were found, the presence of ascites was confirmed by ultrasonography or diagnostic paracentesis and graded clinically as mild, moderate or severe. Ascites tended to occur with a cWHVP > 15 mmHg and plasma albumin 1.23, ascites was not clinically detectable and these patients no longer required diuretics. The clinical applicability of this ratio was assessed in 16 patients who had no detectable ascites but who were still receiving diuretics. In all 10 patients with a ratio > 1.23 diuretics were ceased without reaccumulation of ascites. Thus this ratio may be used to predict when patients no longer require diuretic therapy.

Collagenous colitis: Clinical and histological spectrum in ten patients

Abstract: Collagenous colitis is characterized by the presence of a thick subepithelial collagen band in the colonic mucosa. The condition was diagnosed on rectal biopsy in 10 patients (one male, nine females) who presented with watery diarrhoea. Although rectal mucosal erythema was present in three and ulceration in two, the mucosa was of normal endoscopic appearance in five of the patients. There was marked variability in the thickness of the submucosal collagen band, both between and within individuals. Empirical drug therapy included sulphasalazine, glucocorticoids and antidiarrhoeals. All patients reported symptomatic improvement.

Bile acid composition in primary hepatocellular carcinoma

Abstract: Bile acid composition in human primary hepatocellular carcinoma (HCC) tissues from eight non-hyperbilirubinaemic patients was compared with that in the neighbouring liver tissues. Quantitation of bile acids was carried out using selected ion monitoring. Significant amounts (>14 pmol/mg liver) of bile acids were found to be present in HCC tissues of all patients. In four patients, the concentration of chenodeoxycholic acid was higher in HCC than the corresponding neighbouring liver tissues, whereas those of other bile acids were less. The ratio of cholic to chenodeoxycholic acid was lower in HCC than in adjacent liver tissues in seven out of eight patients. This may indicate predominant synthesis of chenodeoxycholic acid in HCC tissues. The large inter-individual variation in bile acid concentration and composition of HCC tissues may result from the grade of anaplasia of HCC cells. 3β-Hydroxy-5-cholenoic acid, thought to be excreted in increased amounts in the urine of HCC patients, was shown to be a minor constituent of HCC tissues and of the neighbouring liver tissues in most patients, indicating that the C26-hydroxylation pathway plays a minor role. Unusual bile acids, such as 23-nor-3α,7α,12α-trihydroxy-5β-cholanoic, 3β,7β-dihydroxy-5β-cholanoic, 7-oxo-3α,12α-dihydroxy-5β-cholanoic and 12-oxo-3α,7α-dihydroxy-5β-cholanoic acids, were found in trace amounts in HCC tissues but their significance is not clear at present.

Serum pancreatic secretory trypsin inhibitor in pancreatic diseases

Abstract: To elucidate the diagnostic significance of serum pancreatic secretory trypsin inhibitor (PSTI) in pancreatic diseases, organ distribution of PSTI and abnormalities in serum PSTI were studied. The pancreas showed the highest content of PSTI, which was five times that of the stomach and almost 40 times that of the other organs. Serum PSTI and amylase were elevated in eight patients with acute pancreatitis, 27 and 11 patients of 47 with chronic pancreatitis, 31 and 13 of 36 with pancreatic cancer, and 67 and 62 of 109 with non-pancreatic disease, respectively. PSTI levels were more sensitive to the presence of pancreatic disease than were amylase levels. The specificities in serum of healthy controls and patients with non-pancreatic disease were similar for PSTI and amylase (69% vs 71%). In chronic pancreatitis and pancreatic cancer patients the efficiency of the PSTI assay was higher (P < 0.02) than the amylase assay (67% vs 63% for pancreatitis and 71% vs 66% for cancer). The sensitivity and efficiency of serum PSTI assay in chronic pancreatic diseases were superior to those of amylase.