Eisuke Nakashima

Hepatitis C virus RNA present in saliva but absent in breast‐milk of the hepatitis C carrier mother

In order to examine whether saliva and breast‐milk are mediators of the vertical transmission of hepatitis C virus (HCV) from an HCV carrier mother, serum, saliva, and breast‐milk samples from 11 HCV carrier mothers were collected at the time of delivery, and at approximately 1‐ to 3‐month intervals for as long as 30 months postpartum. Serum was also sampled from their children. All samples were analysed for the presence of HCV RNA, using the nested polymerase chain reaction method. No HCV RNA was detected in any breast‐milk samples. In saliva, HCV RNA was detected in four of the 11 mothers (36%). These four mothers also had liver function abnormalities. Hepatitis C virus RNA was not detected in any serum samples of the children, and all children had normal liver function. The children were monitored for periods from 2 to 44 months. During this period, there was no evidence of virus transmission. Breast‐milk is not likely to be a source of mother‐to‐child transmission of HCV. Maternal saliva may harbour HCV, but it may not result in infant infection.

Urinary 7α-hydroxy-3-oxochol-4-en-24-oic and 3-oxochola-4,6-dien-24-oic acids in infants with cholestasis

BACKGROUND/AIMS Urinary 3-oxo-delta4 bile acids have been detected in infants who ultimately died of liver disease. We used qualitative and quantitative methods to compare urinary 3-oxo-delta4 bile acids in liver disease, determining their composition and evaluating the prognostic implication in patients of various ages with various liver diseases. METHODS Gas chromatography-mass spectrometry was used to measure 3-oxo-delta4 bile acids in the urine of patients and healthy controls. RESULTS Patients with a deficiency of 3-oxo-delta4-steroid 5beta-reductase and acute hepatic failure exhibited a significantly higher percentage of 3-oxo-delta4 bile acids in total bile acids in urine than the healthy controls or other patient groups, including those with neonatal cholestasis or biliary atresia (p<0.0001). The urinary 3-oxo-delta4 bile acids in patients with 3-oxo-delta4-steroid 5beta-reductase deficiency who had a poor prognosis were mainly 7alpha-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxochola-4,6-dien-24-oic acid. CONCLUSIONS Our results indicate that an increase in the 7alpha-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxochola-4,6-dien-24-oic acid in the urine of patients with hepatobiliary disease indicates a poor prognosis.

Intussusception in neonates: Analysis of 14 Japanese patients

Objective:  To clarify the clinical features and pathogenesis of intussusception in neonates.

Intestinal Absorption of Ursodeoxycholic Acid in Children and Adolescents with Inflammatory Bowel Disease

BACKGROUND Ursodeoxycholic acid absorption in the proximal intestine may be impaired in patients with inflammatory bowel disease. METHODS We examined the intestinal absorption of ursodeoxycholic acid by the oral ursodeoxycholic acid tolerance test in 19 children and adolescents with inflammatory bowel disease at various stages, including 8 patients with unoperated Crohns disease, 3 patients with ileal-resected Crohns disease, 8 with ulcerative colitis, and 8 healthy control subjects. RESULTS Ursodeoxycholic acid malabsorption was present in all patients with unoperated Crohns disease in the first diagnosed active stage, in 3 of 5 patients in a relapsing active stage, and in 2 of 8 patients in remission. Ursodeoxycholic acid absorption was significantly lower in patients in the first diagnosed active stage than in the healthy controls (p < 0.01) or in patients in remission (p < 0.01). There was no significant difference between healthy controls and the patients in a relapsing active stage or in remission. Ursodeoxycholic acid absorption was abnormal during the first postoperative month in patients with ileal-resected Crohns disease, but normalized over time. Malabsorption of ursodeoxycholic acid was not observed in any patients with ulcerative colitis. CONCLUSIONS These findings suggest that absorption of ursodeoxycholic acid in the proximal intestine is impaired in patients with Crohns disease and that the oral ursodeoxycholic acid tolerance test is a convenient and useful means of evaluating the absorption of bile acid in the proximal intestine in pediatric patients with ileal or ileocolic Crohns disease.

Efficacy of interferon-α treatment in Japanese children with chronic hepatitis C

Background: We investigated the efficacy of natural interferon (IFN)‐α treatment in 34 Japanese children with chronic hepatitis C.

Neonatal cholestasis in two siblings: A variant of Dubin-Johnson syndrome?

: Two Japanese brothers with neonatal cholestasis associated with pigment granules in the hepatocytes and hepatosteatosis were evaluated for the possible role of hepatosteatosis in the Dubin‐Johnson syndrome.

Extracorporeal leukocyte removal therapy for patients with ulcerative colitis

Background: The purpose of the present paper was to investigate efficacy of leukocytapheresis (LCAP) or granulocytapheresis (GCAP) in pediatric patients with ulcerative colitis (UC), including reduction of the total dose and side‐effects of corticosteroids.

Two neonates with intussusception accompanying severe hypoxia.

Intussusception is common in childhood, and its clinical manifestations and treatment are well described. However, intussusception is assumed to be very rare in neonates, and in many such cases have been difficult to diagnose and treat. We recently encountered two neonates with intussusception; one had respiratory distress, while the other had congenital heart disease. Although intussusception was treated surgically, both patients died of underlying diseases.

Serum hyaluronate level correlates to the degree of liver fibrosis in pediatric liver diseases

Usefulness of monitoring a serum marker for liver fibrosis, hyaluronate, for various pediatric liver diseases was examined. Subjects were 73 children who had been followed in the Department of Pediatrics and Child Health, Kurume University School of Medicine for liver function disorders, and who received liver biopsy and serum sampling. Serum hyaluronate levels were measured by using the sandwich binding protein assay system. Collagen fibers in each biopsy specimen were stained with Sirius red, and the amount of the stained fibers were measured by a computer image analysis system in order to obtain the degree of fibrosis, i.e. ratio of the area of collagen fibers to the entire liver specimen. Pearson’s correlation coefficient and regression analysis revealed a significant correlation between the serum hyaluronate level and degree of fibrosis (r=0.687, P<0.001). This result shows the measurement of the serum hyaluronate is useful as a noninvasive method of assessing liver fibrosis in pediatric liver diseases, and it would be able to reduce the frequency of liver biopsy in children.

Acute severe hepatitis: successful prevention of fulminant hepatic failure with early intensive medical therapy.

There is a strong possibility that acute severe hepatitis will evolve into fulminant hepatic failure (FHF). At King’s College Hospital, between 1982 and 1994, 29 children of 44 with FHF (66%) who did not undergo liver transplantation died. 1 Once acute severe hepatitis develops into FHF, only liver transplantation is a reliable cure. It is reported that the prognosis of FHF can be predicted precisely. 2,3 Artificial liver support may only provide a ‘bridge to transplantation’. 4 However, organ shortage is a serious problem. We describe a patient who was at high risk for FHF who was cured with early intensive medical therapy.