Showing papers in "Journal of Gastroenterology and Hepatology in 1988"
TL;DR: The complete nucleotide sequence was determined for a hepatitis B virus genome of subtype adw (pFDW294) isolated and cloned from the plasma sample of a Philippino with a point mutation at the 1376th nucleotide that affected the coding capacity of the P and X genes.
Abstract: The complete nucleotide sequence was determined for a hepatitis B virus genome of subtype adw (pFDW294) isolated and cloned from the plasma sample of a Philippino. The genome was 3221 base-pair long with a point mutation at the 1376th nucleotide that affected the coding capacity of the P and X genes. There was a wide range of sequence divergence among pFDW294 and the reported three genomes of the same subtype (1.1–9.9%), occurring more often in the pre-S region and the S gene than in the pre-C region and the C gene.
44 citations
TL;DR: Liver cancer is the most common fatal neoplasm in Thailand, and is responsible for 16.3% of all new cancers in males, and 5.5% in females, and in recent years, at least, these proportions have been constant.
Abstract: Liver cancer is the most common fatal neoplasm in Thailand, and is responsible for 16.3% of all new cancers in males, and 5.5% in females. In recent years, at least, these proportions have been constant. In males, hepatocellular cancer is the predominant subtype, with an incidence 3.6 times that in females. In females, however, cholangiocarcinoma is slightly more common, incidence exceeding that of hepatocellular carcinoma after the age of 45. Geographic variation in the frequency of hepatocellular carcinoma is quite small (less than twofold), whereas the frequency of cholangiocarcinoma varies more than 12-fold between regions, and its occurrence relates to the endemic nature of the liver fluke Opisthorchis viverrini.
40 citations
TL;DR: Enteric‐coated capsules containing peppermint oil were compared with placebo in a double‐blind crossover trial involving 25 patients with the irritable bowel syndrome, carefully selected for the predominance of colonic symptoms.
Abstract: Enteric-coated capsules containing peppermint oil were compared with placebo in a double-blind crossover trial involving 25 patients with the irritable bowel syndrome, carefully selected for the predominance of colonic symptoms. Patients were randomly allocated to receive active drug or placebo, three capsules per day, for 4 weeks and then changed to the alternative medication for a further 4 weeks. Symptom scores were assessed by the patient using visual analogue scales. While on peppermint oil, there was a small but statistically significant increase in stool frequency but no significant change in scores for global severity or scores for the specific symptoms of pain, bloating, urgent defecation and the sensation of incomplete evacuation. Seven patients failed to complete the study, three because of perianal burning associated with peppermint oil. Enteric-coated capsules containing peppermint oil are unhelpful in patients with the irritable bowel syndrome and prominent colonic symptoms.
31 citations
TL;DR: There are two principal hypotheses for halothane-induced liver injury, and at first glance they appear to be diametrically opposed, but the evidence supporting these alternative mechanisms is discussed, with particular emphasis on recent studies.
Abstract: The initial suggestion that halothane (2chloro-2-bromo-l,1,1 -trifluoroethane) was responsible for rare instances of postoperative hepatic injury (halothane hepatitis) caused a furore which persisted for more than a decade.’-3 Now all but a few truculent and sceptical anaesthetists accept halothane hepatitis as a clinical The controversy surrounding halothane hepatitis has continued, however, both in relation to the present use of this valuable agent,6” and in respect of the likely mechanism whereby it can produce hepatic necrosis which is frequently There are two principal hypotheses for halothane-induced liver injury, and at first glance they appear to be diametrically opposed. The demonstration that the development of hepatic necrosis in experimental animals can be modulated by perturbations of halothane metabolism is consistent with a toxic mechanism. Conversely, potentially relevant immune phenomena have been observed in patients with this entity. Despite the failure, so far, to demonstrate the mechanistic importance of these phenomena, some workers believe that halothane hepatitis is the archetype of an immune-mediated hepatic drug r e a ~ t i o n . ~ In this review the evidence supporting these alternative mechanisms is discussed, with particular emphasis on recent studies, and on the central role of halothane metabolism in both proposals.
26 citations
TL;DR: It has become increasingly recognized over the past decade that, apart from causing gastro‐oesophageal varices, portal hypertension has effects on the remainder of the gastrointestinal tract, in particular, the gastric mucosa.
Abstract: It has become increasingly recognized over the past decade that, apart from causing gastro-oesophageal varices, portal hypertension has effects on the remainder of the gastrointestinal tract, in particular, the gastric mucosa. There have been numerous reports suggesting that ‘hypertensive’ gastric mucosa is a frequent cause of haemorrhage in patients with portal hypertension; the condition has been variously described as haemorrhagic gastritis, erosive gastritis, portal hypertensive gastritis, congestive gastropathy, gastric mucosal red spots, gastric mucosal vasculopathy or portal hypertensive gastropathy (PHG). The feature in common with all these descriptions is the observation of a gastric mucosal lesion which has a propensity to bleed.
18 citations
TL;DR: The overall incidence of achalasia was similar in North and South Islands and in men and women and the incidence increased with age and was 5.4/100 000 population per year in people aged over 80 years old.
Abstract: One hundred and fifty-two patients with achalasia were first admitted to hospital in New Zealand between 1980 and 1984. The discharge of these patients was recorded by the National Health Statistics Centre which records details of all public health hospitals in New Zealand. The overall incidence was 0.95/100 000 population per year and was similar in North and South Islands and in men and women. The incidence increased with age and was 5.4/100 000 population per year in people aged over 80 years old. The disease was more common in Polynesian migrants (1.3/100 000 population per year) than other ethnic groups. Variations in incidence were seen across the Health Boards with the highest incidence of 2.9/100 000 population per year in Hawkes Bay and Tauranga.
17 citations
TL;DR: This update concerns epidemiology, pathology, change in bile leading to the formation of intrahepatic calculi, bacteriology, flow dynamics in biliary tract, diagnostics, treatment and prognosis of hepatolithiasis mainly based on the experiences of the Hepatolithiasis Research Group of the Ministry of Health of Japan for which the author served as a chairman during 1981-87.
Abstract: Hepatolithiasis or intrahepatic calculi mostly affect populations in East Asia and constitute one of the most troublesome disease entities encountered in daily practice in this part of the world.’,’ This is in sharp contrast to cholelithiasis in which stones are usually found in the gall-bladder and/or extrahepatic bile-duct. They mostly consist of either cholesterol gallstones or black pigment stones. In a few cases, calcium bilirubinate stones are found in extrahepatic bile-duct and/or gall-bladder. Operative intervention usually ensures complete recovery from the ailment. In hepatolithiasis, however, complete recovery after operative intervention is rather exceptional and repeated operative intervention as well as trials for stone removal are the rule. Therefore, this disease has attracted much attention recently, especially in East Asia. Several reviews have been published 3-8; this update concerns epidemiology, pathology, change in bile leading to the formation of intrahepatic calculi, bacteriology, flow dynamics in biliary tract, diagnostics, treatment and prognosis of hepatolithiasis mainly based on the experiences of the Hepatolithiasis Research Group of the Ministry of Health of Japan for which the author served as a chairman during 1981-87.
15 citations
TL;DR: Serial liver biopsy showed that in the late evolution of cirrhosis, hepatitic activity tended to decline, which may represent the intermediate stage between CAH and inactive liver Cirrhosis.
Abstract: To clarify the natural history of hepatitis B virus (HBV)-associated liver cirrhosis, the clinical, laboratory and histological features of 174 untreated hepatitis B surface antigen (HBsAg)-positive cirrhotics were analysed, with a mean follow-up period of 34 months (range 8–135 months) after liver biopsy. Male patients were predominant (86.8%) and the mean age of the whole group was 45 years, s.d. = 12 (range 15–82 years). Serum HBeAg and HBV-DNA positivity were 38.9% and 31.8%, respectively. The calculated annual rate of spontaneous HBeAg seroconversion was 6.4% which was significantly lower than that (12%) of patients with HBeAg-positive chronic active hepatitis (CAH). Superinfection by δ-agent was rare, and anti-δ antibody was detected in only 1.7% of them. The occurrence rate of hepatocellular carcinoma in the whole group was 5.7%/year which was not higher than that of HBsAg-negative cirrhotics (6.2%/year). Serial liver biopsy showed that in the late evolution of cirrhosis, hepatitic activity tended to decline. Active cirrhosis may represent the intermediate stage between CAH and inactive liver cirrhosis. The 5-year survival probability rate of the patients belonging to Child's functional classes A, B and C was 83.4% (s.d. = 5.7), 79.2% (s.d. = 9.4) and 30.9% (s.d. = 14.3), respectively. Most patients were in a well-compensated state on entry into the study and remained stable for several years after diagnosis. Major causes of death include massive variceal bleeding, hepatic failure and/or hepatorenal syndrome, infection and hepatocellular carcinoma.
12 citations
TL;DR: Chilli ingestion, therefore, does not lead to macroscopic gastroduodenal mucosal damage and should not be considered a cause for concern.
Abstract: Thirty-eight healthy subjects who had normal index endoscopies were re-endoscoped following ingestion of 20 g of chilli powder with 400 ml of water, 600 mg aspirin BP with 400 ml of water or 400 ml of water only. There were good correlations between endoscopic scores given by two endoscopists who independently recorded their findings, as well as with scores given by a third observer viewing photographs taken at endoscopy. There were statistically significant differences between the aspirin group and the other two groups but not between the chilli and the control groups. Chilli ingestion, therefore, does not lead to macroscopic gastroduodenal mucosal damage.
12 citations
TL;DR: The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction, and a study of blood groups revealed that there was no relationship between blood group and duodenal or Gastric ulcer.
Abstract: The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.
9 citations
TL;DR: Its natural history and consequently its management are under dispute; whereas some authors believe that children with EHO outgrow their disease by adolescence">'* and should therefore be provided only supportive treatment.
Abstract: Its natural history and consequently its management are under dispute; whereas some authors believe that children with EHO outgrow their disease by adolescence\">'* and should therefore be provided only supportive treatment.I3 others think it is a more dangerous disease14 and active measures like endoscopic s~lerotherapy, '~~' ' propranolol'* or portasystemic shunts should be ~ f fe red . '~ 40?40.~-'~
TL;DR: The hypothesis that increased central nervous system (CNS) GABA-ergic neurotransmission (tone) contributes to the clinical and electrophysiological manifestations of HE is updated, and provides the basis of a new approach to the treatment of this syndrome utilizing agents which specifically decrease GABAergic tone.
Abstract: Hepatic encephalopathy (HE) is a complex neuropsychiatric disorder that occurs as a complication of acute or chronic hepatocellular failure, and is associated with increased shunting of portal venous plasma constituents to the systemic cir~ulation.’-~ Despite many investigations of this syndrome, its pathogenesis has not been fully elucidated. A number of neurotoxic or neuroactive metabolites (such as ammonia, mercaptans, short chain fatty acids, phenols, phenylalanine, tyrosine, tryptophan, phenylethanolamine, octopamine, noradrenaline, serotonin and dopamine) are found in increased concentrations in plasma, cerebrospinal fluid or brain extracts in animal models and humans with liver failure. However, definitive evidence that any of these substances mediate HE is currently lacking. Nonetheless, it is possible that one or more of these metabolites plays a role in the pathogenesis of HE. Recently, behavioural, electrophysiological and neuropharmacological investigations of this syndrome strongly suggest that the brain y-aminobutyric acid (GABA)/benzodiazepine (BZ)-receptor chloride ionophore complex plays a role in mediating HE.4-’3 This review updates the hypothesis that increased central nervous system (CNS) GABA-ergic neurotransmission (tone) contributes to the clinical and electrophysiological manifestations of HE, and provides the basis of a new approach to the treatment of this syndrome utilizing agents which specifically decrease GABAergic tone. This “rostral” approach to therapy may supplement rather than replace the established “caudal” approach to the management of HE (that is, therapeutic manoeuvres that reduce the interaction between gut bacteria and nitrogenous substances).
TL;DR: Lower levels of PGE2 in patients with antral or duodenal ulcer and of P GE2 and PGF1α in patientswith corpus ulcer in the anatomical mucosal area including the ulcer site may predispose the mucosa to ulceration.
Abstract: The levels of prostaglandin E2 (PGE2), 6-keto-prostaglandin F1α (PGF1α) and thromboxane B2 (TXB2) in endoscopic biopsy specimens from the gastric and duodenal mucosa of healthy volunteers and ulcer patients were measured by radio-immunoassay. The PGE2 and PGF1α levels in the mucosa of the corpus of the stomach were lower and the TXB2 level was higher in 10 patients with gastric ulcer in the corpus than in the 16 healthy subjects. The PGE2 level in the antral mucosa of 14 patients with gastric ulcer in the antrum was lower than in the controls. In 18 patients with duodenal ulcer, PGE2 deficiency was more widespread in the entire gastric and duodenal mucosa while the reduced PGF1α level was limited in the gastric corpus. Lower levels of PGE2 in patients with antral or duodenal ulcer and of PGE2 and PGF1α in patients with corpus ulcer in the anatomical mucosal area including the ulcer site may predispose the mucosa to ulceration.
TL;DR: The lifting of the seventh veil, the ultimate understanding of AI‐CAH, will require the following: consensus on criteria for specifying auto‐immune hepatitis as an entity; identification of a liver‐specific auto‐antigen (or hepatocellular neo-antigen) as target of the immune attack.
Abstract: Knowledge of auto-immune chronic active hepatitis (AI-CAH) has developed since the 1940s. Using the analogy of the seven veils, the lifting of the first six could be represented by the finding of: hypergammaglobulinaemia; recognition of the clinical syndrome; the hepatic histopathology; the auto-immune serological markers; the response to corticosteroid/immuno-suppressive drugs; and the immunogenetic association with HLA B8; DR3. The lifting of the seventh veil, the ultimate understanding of AI-CAH, will require the following: consensus on criteria for specifying auto-immune hepatitis as an entity; identification of a liver-specific auto-antigen (or hepatocellular neo-antigen) as target of the immune attack; the nature of the immune effector process which causes hepatocellular destruction; the basis of the deranged immunoregulatory processes expressed as decreased immune suppressor activity; and processes by which ‘anti-immune’ drugs exert their ameliorative effects. Auto-immune hepatitis is not unique in the paucity of data on these questions.
TL;DR: This review was prompted by the increasing prevalence of specific infection within the community, a reawakening of interest in luetic hepatitis over the past two decades, and a low index of suspicion among clinicians.
Abstract: A universal decline of syphilis during the 1860-1910 period was followed by an anticipated upsurge of the disease following the two World Wars. In the United States a peak of reported early infectious cases in 1947 declined to a low point in 1954.’ A sharp increase in 1959 was sustained by the sexual revolution. During the years 1971-77 the number of early infectious cases of lues attending venereal disease clinics in the United Kingdom increased by a factor of 1.5; 54% of 1364 cases were homosexually acquired in 1977.2 In the United States the rate of infection increased by 26.3% from 9.5/ 100000 population in 1977 to 12/100000 population in 1980; there were 27 204 cases reported in 1980.3 This review was prompted by the increasing prevalence of specific infection within the community, a reawakening of interest in luetic hepatitis over the past two decades, and a low index of suspicion among clinicians. EARLY SYPHILIS OF THE LIVER
TL;DR: Physiological evidence indicates that vasoactive intestinal peptide is contained in secretomotor neurons and is a powerful stimulant of secretion; loss of function restricted to these neurons is consistent with the clinical manifestations of CF.
Abstract: Cystic fibrosis (CF) is the most common lethal or debilitating inherited disease amongst Caucasians, with estimates of its frequency of occurrence in this population ranging from 1: 2000 to 1: 15 000 live births. It is characterized by disorders of exocrine secretions, primarily of the skin, respiratory tract and digestive system. The secretory processes of these tissues are influenced by autonomic nerve fibres, many of which contain regulatory peptides. The innervation of the intestinal and respiratory mucosa of CF patients has been investigated in order to determine if there is any derangement of the peptide-containing nerve fibres that supply these tissues. The present work demonstrates that, in CF, there is a deficiency of vasoactive intestinal peptide immunoreactivity (VIP-IR) in nerve fibres in the nasal and intestinal mucosa. There is not a generalized loss of fibres that are immunoreactive for this peptide, however, since VIP-IR fibres innervating the intestinal muscle are largely unaffected. Moreover, other types of nerve fibres innervating the nasal mucosa and the mucosa of the intestinal villi appear to be unaffected in CF patients. Physiological evidence indicates that vasoactive intestinal peptide is contained in secretomotor neurons and is a powerful stimulant of secretion; loss of function restricted to these neurons is consistent with the clinical manifestations of CF.
TL;DR: Simultaneous determination of GGTII, ALPI, α1AT and AFP is useful in the diagnosis of PLC, especially PLC with negative AFP or slightly increased AFP.
Abstract: Simultaneous determination of serum levels of specific γ-glutamyltransferase isoenzyme II (GGTII) and alkaline phosphatase isoenzyme I (ALPI), α1-antitrypsin (αAT) and α-fetoprotein (AFP) was carried out in 101 patients with primary liver cancer (PLC), 60 with liver cirrhosis, 66 with chronic hepatitis, 14 with benign space occupying lesion of the liver and 100 normal subjects. The positivity rates for GGTII, ALPI, α1AT and AFP in patients with PLC were 85.1%, 24.8%, 75.1% and 76.2% respectively; significantly higher than those in the other patients and normal subjects. In the PLC group, the positivity rates for combined determination of AFP and GGTII or α1AT were 93.1% and 92.1% respectively, significantly higher than single determination of AFP. The results of simultaneous determination of GGTII, ALPI, α1AT and AFP in the area of PLC patients showed that the sensitivity of at least one positive marker was as high as 98% and the specificity of at least two positive markers was 94.3%. Of PLC patients with AFP ≤ 50 ng/ml; ≤ 200 ng/ml and ≤ 400 ng/ml, 91.7%, 93.8% and 90.5% respectively, were diagnosed with combined determination of GGTII, ALPI and α1AT. Thus, simultaneous determination of GGTII, ALPI, α1AT and AFP is useful in the diagnosis of PLC, especially PLC with negative AFP or slightly increased AFP.
TL;DR: It is concluded that active duodenal ulceration and MAO manifest significant variation by month, but their peaks do not coincide, indicating that acidity is unlikely to be a major factor responsible for the frequency of duodentaler ulcer peaking in winter.
Abstract: The frequency of duodenal ulcer has been reported to vary seasonally. It is not known whether gastric acid secretion of patients with this condition has similar seasonal variation. During 1981–85, 1864 patients (mean age 38.0 years, s.d. = 24.2, males comprising 67.1%) with newly diagnosed active duodenal ulcer were documented endoscopically. Of these 626 patients (mean age 38.5 years, s.d. = 15.0, males comprising 71.4%) agreed to have their basal acid output (BAO) and pentagastrin-stimulated maximal acid output (MAO) measured. Time series analysis using the frequency domain approach identified that the monthly frequencies of duodenal ulcer over the 5-year period occurred in cycles of 12 months. Multiple comparison using Duncan's procedure identified the occurrence of a significant peak in November and December. MAO varied significantly (P < 0.04) with season with two peaks, one occurring in February and another in July. Month-adjusted MAO was significantly higher (P < 0.001) in male than in female patients. BAO showed no significant variation by month. It is concluded that active duodenal ulceration and MAO manifest significant variation by month, but their peaks do not coincide, indicating that acidity is unlikely to be a major factor responsible for the frequency of duodenal ulcer peaking in winter. These results also suggest that it is advisable to adjust for seasonal variation when MAO is compared among groups of duodenal ulcer patients.
TL;DR: Serological markers of hepatitis δ virus (HDV) and hepatitis B virus (HBV) infection were studied in 87 HBsAg positive patients and superinfection by HDV in chronic HBV carriers was the predominant form of infection in patients with FHF, SAHF and CAH.
Abstract: Serological markers of hepatitis δ virus (HDV) and hepatitis B virus (HBV) infection were studied in 87 HBsAg positive patients, comprised of 18 patients with uncomplicated acute viral hepatitis (AVH), 34 patients with fulminant hepatic failure (FHF), 18 patients with subacute hepatic failure (SAHF) and 17 patients with chronic active hepatitis (CAH). The prevalence of HDV infection was found to be 27.8%, 20.6%, 16.7% and 11.8%, respectively in these four groups. Co-infection of HDV and HBV was common amongst patients with AVH but superinfection by HDV in chronic HBV carriers was the predominant form of infection in patients with FHF, SAHF and CAH. HDV superinfection in these groups did not significantly alter the common tests of liver function or the DNA-polymerase positivity.
TL;DR: The prevalence and duration of lactose malabsorption was studied in 64 Central Australian Aboriginal children requiring hospitalization for acute enteritis and it was found that only three of 32 aboriginal children were lactose‐tolerant after 3 months.
Abstract: The prevalence and duration of lactose malabsorption was studied in 64 Central Australian Aboriginal children requiring hospitalization for acute enteritis. Lactose malabsorption was determined by the breath-hydrogen test. Sixty-nine per cent were shown to malabsorb lactose, a figure similar to that for well nourished urban European children, hospitalized for acute enteritis. Whereas 90 per cent of the European children became lactose-tolerant 1 month later, only three of 32 aboriginal children were lactose-tolerant after 3 months. Lactose malabsorption was also associated with more frequent hospitalizations in affected children.
Coronavirus-like particles were the commonest agent isolated from Aboriginal children. The majority of the Aboriginal children were malnourished (< 80% standard weight for age) which may have been contributed to by their lactose malabsorption and explain why this failed to recover in the same way as European children. The possibility of lactose malabsorption must be taken into consideration when managing Aboriginal children with acute diarrhoeal disease and undernutrition. The use of the breath-hydrogen test allows an accurate diagnosis of lactose malabsorption to be made in Aboriginal children with diarrhoea so that appropriate dietary management can be instituted.
TL;DR: The prevalence of hepatitis δ virus (HDV) was evaluated in 1027 HBsAg positive people living in five provinces, two municipalities and four autonomous regions of China and 17 people had antibodies to HDV, including those who were anti‐HD.
Abstract: The prevalence of hepatitis δ virus (HDV) was evaluated in 1027 HBsAg positive people living in five provinces, two municipalities and four autonomous regions of China. Seventeen people had antibodies to HDV (anti-HD — 13 of 454 asymptomatic carriers of HBsAg, two of 151 patients with chronic persistent hepatitis and two of 59 patients with chronic active hepatitis). All of those who were anti-HD lived in the autonomous regions of Inner Mongolia, Tibet, and Xinjiang.
TL;DR: The influence of duodenal infusion of bile acid at a concentration similar to that in the common bile‐duct (50 mmol/1) on antroduodinal motility, Duodenogastric reflux, gastric and duodental secretion was studied in 10 healthy volunteers.
Abstract: The influence of duodenal infusion of bile acid at a concentration similar to that in the common bile-duct (50 mmol/1) on antroduodenal motility, duodenogastric reflux, gastric and duodenal secretion was studied in 10 healthy volunteers. Intraluminal pressures were recorded in the antrum and the first and second parts of the duodenum. Gastric and distal duodenal contents were collected by continuous low pressure sump aspiration during infusion of either saline or chenodeoxycholic acid (CDC) into the second part of the duodenum. Values for duodenogastric reflux and gastric and duodenal secretion were calculated with reference to the recovery of two non-absorbable markers infused into the stomach and second part of the duodenum. Each volunteer received at least 3 h of saline infusion and 2 h of CDC infusion.
During saline infusion, duodenogastric reflux varied with the migrating motor complex (MMC), being statistically greater at the end of duodenal phase III activity than at other times (P<0.05). Infusion of CDC abolished the MMC and inhibited antral contractions but the amount of reflux was not increased compared with the saline period. Infusion of CDC also produced marked increases in measured bicarbonate (P<0.001), trypsin (P<0.001), phospholipase A2 (P<0.05) and endogenous total bile acid (P<0.05) in the duodenum, although gastric acid secretion was unaffected. These findings suggest that bile acid may regulate gastroduodenal motor activity and pancreaticobiliary secretion.
TL;DR: Findings indicate the presence of local mucosal suppressive factors in some patients with Crohn's disease and could suggest that the diminished ability of macrophages to accumulate in a focus of inflammation may be an underlying mechanism for the failure to form granulomata in these patients.
Abstract: The chemotactic migration in vitro of intestinal macrophages and peripheral blood monocytes has been assessed in patients with Crohn's disease, ulcerative colitis, and miscellaneous intestinal diseases. In all groups, the chemotaxis of peripheral blood monocytes was similar to that of healthy subjects. Intestinal macrophages migrated similarly to autologous monocytes in patients with ulcerative colitis and in the miscellaneous group. In contrast, intestinal macrophages from patients with Crohn's disease exhibited a wide range of chemotaxis from markedly suppressed to normal. This variation was independent of drug treatment and the degree of inflammation present. However, patients in whom granulomata were not present exhibited a significant depression of chemotaxis compared with those with granulomata, with disease controls (ulcerative colitis patients), and with the miscellaneous group. Such a difference was not reflected in monocytes from autologous peripheral blood. These findings indicate the presence of local mucosal suppressive factors in some patients with Crohn's disease and could suggest that the diminished ability of macrophages to accumulate in a focus of inflammation may be an underlying mechanism for the failure to form granulomata in these patients.
TL;DR: The virologic profiles and pathologic features in 10 infants with fulminant hepatitis and aged 2–7 months suggest that cytoplasmic HBcAg and anti‐HBc IgM may be related to the occurrence of severe liver disease.
Abstract: This study examined the virologic profiles and pathologic features in 10 infants with fulminant hepatitis and aged 2–7 months. Nine male infants were related to hepatitis B virus infection: as evidenced by positive anti-HBc IgM (4 cases); positive serum HBsAg, and/or liver HBcAg (4 cases); or born to an HBsAg carrier mother (1 case). Only one female infant had presumed non-A non-B fulminant hepatitis, but none had hepatitis A. The mothers of eight infants with HBV-ralated fulminant hepatitis were all positive for serum HBsAg, and most (5/6) were negative for HBeAg but positive for anti-HBe. These findings suggest that infants born to HBsAg carrier mothers, particularly those who are negative for HBeAg, may contract fulminant hepatitis B in infancy in Taiwan. Six infants studied had massive hepatic necrosis and all died, whereas four had submassive or bridging hepatic necrosis and all survived, suggesting a close correlation between the extent of liver necrosis and the patient's outcome. None of the infants had hepatocyte HBsAg, although four had cytoplasmic HBcAg. Anti-HBc IgM was commonly detected (4/6), in sharp contrast to the constant negativity in infants who had contracted an asymptomatic HBV infection. These findings suggest that cytoplasmic HBcAg and anti-HBc IgM may be related to the occurrence of severe liver disease.
TL;DR: The in vitro natural killer activity of peripheral blood lymphocytes (PBL) was assessed in patients with genetic haemochromatosis and normal subjects, using a 51Cr‐release cytotoxicity assay against the target K‐562 leukaemic cell line.
Abstract: The in vitro natural killer (NK) activity of peripheral blood lymphocytes (PBL) was assessed in 13 patients with genetic haemochromatosis (HC) and 27 normal subjects, using a Cr‐release cytotoxicity assay against the target K‐562 leukaemic cell line. Mean NK function did not differ between these two groups. This conclusion differs from the reported deficit in NK activity in other diseases in which increased iron stores may occur, including alcoholic cirrhosis and β‐thalassaemia major. The effect of ferric citrate (0.1–1.0 mmol/1), normal human liver ferritin (100–10 000 μg/1) and transferrin (2 g/1) on NK activity was also assessed for both groups. In neither group was NK activity affected by any of these additives. These results suggest that peripheral blood NK function is not compromised in haemochromatosis, and that the diminished NK activity which has previously been reported in some patients with thalassaemia or alcoholic cirrhosis is due to factors other than to a direct effect of increased iron stores.
TL;DR: Fifty‐eight cases of pancreatic mass lesions investigated by fine needle aspiration biopsy (FNAB) are reported and FNAB is an effective way to obtain cytological confirmation of a pancreaticmass lesion.
Abstract: Fifty-eight cases of pancreatic mass lesions investigated by fine needle aspiration biopsy (FNAB) are reported Biopsies were performed either at laparotomy or percutaneously using ultrasound or computer to mography scanning as a guide Twenty-seven biopsies were reported as consistent with or highly suspicious of adenocarcinoma of the pancreas; five with metastatic carcinoma, one with lymphoma and two with islet cell tumours Nineteen patients had negative biopsies The false-negative rate was 11% and four biopsies were unsatisfactory There were no false-positive diagnoses FNAB is an effective way to obtain cytological confirmation of a pancreatic mass lesion
TL;DR: Investigation of intrahepatic expression of hepatitis B surface antigen and hepatitis B core antigen in asymptomatic HBsAg carriers suggests that membranous HBcAg may represent the major target in the process of injury to hepatocytes.
Abstract: Intrahepatic expression of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) was investigated in 46 asymptomatic HBsAg carriers by a direct immuno-fluorescent method. In 21 HBeAg positive carriers, HBsAg was expressed diffusely on the membrane of hepatocytes, with associated cytoplasmic localization in a few scattered hepato-cytes. HBcAg was expressed in the nucleus of many hepatocytes and in the cytoplasm of a few scattered hepatocytes, but not on the cell membrane. In 25 anti-HBe positive carriers, HBsAg was expressed on the surface and in the cytoplasm of hepatocytes diffusely and/or focally, but neither intrahepatic HBcAg nor serum HBV-DNA was detected. Repeat liver biopsies were performed in 17 patients. In eight of 13 HBeAg-positive HBsAg carriers, who developed histologically proven chronic hepatitis and liver cirrhosis, the localization of HBsAg in liver had changed from a membranous to a mixed (membrane and cytoplasm) pattern, and localization of HBcAg in liver had changed from a predominantly nuclear to a predominantly membranous and cytoplasmic pattern. However, in two HBeAg and two anti-HBe positive cases who showed no biochemical and histologic change at follow-up, the intrahepatic expressions of HBsAg and HBcAg in the second biopsies remained unchanged. Thus, decrease in membranous expression of HBsAg and increase in membranous and cytoplasmic expression of HBcAg were associated with progression to chronic liver disease. This suggests that membranous HBcAg may represent the major target in the process of injury to hepatocytes.
TL;DR: A radioimmunoassay for carboxy terminal peptide of human type I procollagen (type 1 C‐peptide) was developed and its clinical implication for serodiagnosis of hepatic fibrosis in 85 patients with viral hepatitis, 45 patients with post‐hepatitic liver cirrhosis and 37 patients with alcoholic liver diseases was evaluated.
Abstract: In the present investigation, a radioimmunoassay for carboxy terminal peptide of human type I procollagen (type 1 C-peptide) was developed. Its clinical implication for serodiagnosis of hepatic fibrosis in 85 patients with viral hepatitis, 45 patients with post-hepatitic liver cirrhosis and 37 patients with alcoholic liver diseases was evaluated in comparison with that of the previously established amino terminal peptide (type III N-peptide) assay. Anti-sera against type I procollagen was obtained by immunization of rabbit with purified type I procollagen from culture medium of IMR-90.
The serum level of type I C-peptide in normal subjects was found to be 42 ng/ml (s.d. = 19). Type I C-peptide levels in patients with acute hepatitis were within normal range, while in chronic hepatitis, the mean type I C-peptide level increased as the grade of fibrosis advanced from grade I to III. However, there was no statistically significant difference between the mean type I C-peptide level of grade III and that of liver cirrhosis. Increments of type I C-peptide levels were also observed in alcoholic liver fibrosis (fatty liver with fibrosis and liver cirrhosis).
On the other hand, type III N-peptide assay appeared to reflect not only the degree of hepatic fibrosis, but also the degree of hepatic inflammation, giving the high levels in acute viral hepatitis.
Collectively, the results indicate the usefulness of type I C-peptide assay for monitoring hepatic fibrosis in viral hepatitis as well as in alcoholic liver disease.
TL;DR: Serum gastrin levels were reduced after the resection of the head of the pancreas and duodenum, and the secretin test after resection was negative, suggesting that intra‐operative secretinTest is useful for the rapid evaluation of curative operation in case of ZES.
Abstract: The intra-operative measurements of serum gastrin levels and an intra-operative secretin test were carried out as the rapid evaluation of curative operation in a case of Zollinger-Ellison syndrome (ZES). In this case, pre-operative investigations suggested that the tumours were located in the head of the pancreas and the duodenal wall. The surgeon planned a pan-creato-duodenectomy. Serum gastrin levels were reduced after the resection of the head of the pancreas and duodenum, and the secretin test after resection was negative. The surgeon ensured that gastrinomas were resected completely during the operation. The secretin test carried out 1 month post operatively was also negative. The patient has experienced no further complications, to date. This case suggests that intra-operative secretin test is useful for the rapid evaluation of curative operation in case of ZES.
TL;DR: Hormonal manipulation can be achieved by the feeding of specific nutrients or surgical intervention by evaluating the effect of GI hormones on tumour growth, on the growth of tumour cells transplanted into suitable animal models, and on the development of (pre)malignant changes induced by carcinogens.
Abstract: Carcinomas of the gastrointestinal (GI) tract occur frequently and contribute considerably to death due to cancer. Treatment of patients with GI cancer relies heavily on adequate surgical resection. However, this therapy is only effective when localized tumour is present. There is no effective systemic treatment for widespread or metastatic GI cancer. After the first description of endocrine control of breast carcinoma,’ it is now wellknown that breast cancers are often successfully treated by endocrine manipulation, when specific receptors for steroid hormones that stimulate growth of the normal breast are present in the cancer. Since GI hormones have trophic effects on the normal GI tract,* the possibility of influencing growth of GI cancer by GI hormones is gaining interest. Indeed, recent studies in animals have demonstrated that GI hormones can influence the development and growth of GI t~mours .~’ GI hormones may either stimulate or inhibit growth of the normal GI tract. For example, cholecystokinin has a trophic effect on the pancreas which can be inhibited by somatostatin. Several types of studies have been performed to demonstrate the effect of GI hormones on tumour growth. First, studies on the effect of exogenously administered hormones on tumour growth can be done by evaluating the effect of GI hormones on tumour cells in aitro, on the growth of tumour cells transplanted into suitable animal models, and on the development of (pre)malignant changes induced by carcinogens. Second, there are studies on the effect of manipulation of endogenous hormone secretion on the growth of transplanted tumours or the development of tumoral changes by carcinogens. Hormonal manipulation can be achieved by the feeding of specific nutrients or surgical intervention. Third, there are studies on the effect of growth-inhibiting hormones on tumour development and