I. Yap

Chili protects against aspirin-induced gastroduodenal mucosal injury in humans.

Capsaicin, the pungent ingredient of chili, has a gastroprotective effect against experimental gastric mucosal injury in animals. Such an effect has not, however, been documented in humans to date. Eighteen healthy volunteers with normal index endoscopies underwent two studies four weeks apart. Each subject took 20 g chili orally with 200 ml water in one study and 200 ml water in another study. In each case this was followed half an hour later by 600 mg aspirin BP with 200 ml water. Endoscopy was repeated 6 hr later. Gastroduodenal mucosal damage was assessed by a previously validated scoring system. The median gastric injury score after chili was 1.5 compared to 4 in the control group (P<0.05), demonstrating a gastroprotective effect of chili in human subjects.

Chili : protective factor against peptic ulcer ?

The aim of the present study was to determine the frequency and amount of chili taken by peptic ulcer patients and control subjects. One hundred three Chinese patients with peptic ulcer and 87 control patients were interviewed using a standard questionnaire. Those subjects who deliberately avoided chili use because of symptoms or advice from friends or medical practitioners were excluded. The median number of times of chili use per month was eight in the ulcer group (25–75% quartiles 1–30) compared to 24 (8–56) in the control group (P<0.001). The median amount of chili used per month was 312 units (25–75% quartiles 38–899) in the ulcer group compared to 834 units (274–1892) in the control group (P<0.001). The odds ratio of having peptic ulcer disease, adjusted for age, sex, analgesic use, and smoking by multiple logistic regression, was 0.47 (95% confidence intervals: 0.25–0.89) for subjects who had a higher intake of chili both in terms of frequency as well as amount used compared to those who took less chili. Our data support the hypothesis that chili use has a protective effect against peptic ulcer disease.

Analysis of cost‐effectiveness of different strategies for hepatocellular carcinoma screening in hepatitis B virus carriers

A mathematical model was used to calculate the efficacy of screening to detect hepatocellular carcinoma at a resectable stage in hepatitis B virus carriers. Data relating to tumour incidence, efficacy of screening tests and tumour growth times were obtained from a literature review. Various tests were costed according to charges currently prevailing at the authors’ institution. The cost per early tumour detected is inversely proportional to tumour incidence. It is relatively low for populations with high incidences of hepatocellular carcinoma for example, male carriers over the age of 30. Both the costs and the proportions of early tumour detected increase with increasing frequency of screening. However, the use of ultrasonography at 10 monthly intervals or both ultrasonography and α‐fetoprotein estimation at yearly intervals will detect 90% of tumours early at a cost of S

Study on the comparative immunogenicity of a recombinant DNA hepatitis B vaccine containing pre‐S components of the HBV coat protein with non pre‐S containing vaccines

20 000 (US

Racial differences in peptic ulcer frequency in Singapore

11 800) per early tumour detected. The results would be significantly altered if tumour growth times were markedly different from those reported in the literature.

Fine needle aspiration biopsy of small/intermediate cell tumors in the liver : Considerations in a southeast Asian population

Abstract A new recombinant hepatitis B vaccine (SCI‐B‐VAC), derived from Chinese hamster ovary (CHO) cells and consisting of both the major S protein and the minor pre‐S1 and pre‐S2 proteins of the viral coat were compared with two yeast‐derived vaccines containing only S proteins (B‐Hepavac II and Engerix‐B) for immunogenicity in human volunteers in a randomized controlled study. Two hundred and ninety‐five healthy subjects completed the 12 month follow up. There was no difference in the mean age and sex distribution among the three study groups. Seroconversion rates for all the three groups were similar at months 6, 9 and 12. However, hepatitis B surface antibody (anti‐HBs) geometric mean titres (GMT) were significantly higher with 10 μg SCI‐B‐VAC and 20 μg Engerix‐B than with 10 μg B‐Hepavac‐II at months 6, 9 and 12. SCI‐B‐VAC at month 6 also showed a significantly higher anti‐HBs GMT than Engerix‐B (295 vs 143 miu/mL, P < 0.02).

Influence of the site of a duodenal ulcer on its mode of presentation

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.

Dietary Supplementation with Pectin in the Maintenance Treatment of Duodenal Ulcer: A Controlled Study

OBJECTIVE To assess the diagnostic problems and accuracy involved in rendering an exact cytologic diagnosis, including reference to a primary site of origin, on fine needle aspiration biopsies (FNABs) of small/intermediate cell tumors of the liver. STUDY DESIGN Thirty-five hepatic FNABs of small/ intermediate tumors, neuroendocrine tumors (NETs) and poorly differentiated or undifferentiated cancers occurring in adults were analyzed. Ancillary studies, including immunohistochemistry, were performed whenever necessary. All other relevant histopathologic sections and medical records were reviewed. RESULTS There were 26 metastases, while 9 were considered primary lesions. The aspirates were categorized into 11 NETs (pancreas 5, lung 1, liver 2, unknown primary 3); 9 undifferentiated nasopharyngeal carcinomas; 2 small cell undifferentiated carcinomas (lung 2); 4 undifferentiated carcinomas, not otherwise specified (lung 1, pancreas 1, liver 1, unknown 1); 1 lobular-ductal carcinoma (breast); 1 glioblastoma multiforme (brain); 1 ovarian carcinoma; 1 non-Hodgkins lymphoma (liver); and 5 primary hepatocellular carcinomas. CONCLUSION There was histologic and/or immunohistochemical confirmation in 25 cases (71%). Some of the limitations in categorization of such tumors obtained by FNAB can be overcome by immunohistochemistry. Information gleaned from a precise cytologic diagnosis can sometimes only favor a particular primary site.

Hepatocyte hepatitis B surface antigen expression in chronic hepatitis B virus carriers in Singapore: Correlation with viral replication and liver pathology

The aims of this study were to define the localization of duodenal ulcer and to determine whether the site influenced the initial presentation. Eight hundred eighty-four duodenal ulcer patients diagnosed by endoscopy in Singapore and Sydney were studied. The ulcer was situated on the anterior wall of the bulb in 49% and the posterior wall of the bulb in 23%. The distribution was not influenced by sex, age, or the center of diagnosis. Those situated posteriorly in the bulb were more likely to present with hemorrhage than those situated elsewhere.

Lactase deficiency in Singapore-born and Canadian-born Chinese

Patients with recently healed duodenal ulcers diagnosed by endoscopy were randomly allocated to receive 10 g apple pectin USP powder twice daily, 150 mg ranitidine at night, or one tablet matching ranitidine placebo at night for 6 months. Repeat endoscopy was performed at 6 months or if symptoms recurred. Eighty-three patients completed the study. Recurrences occurred in 23 of 27 (85%) patients taking pectin, 6 of 28 (21%) patients taking ranitidine, and 20 of 28 (71%) patients taking placebo. (Pectin versus placebo, NS; ranitidine versus pectin, p less than 0.00001; ranitidine versus placebo, p less than 0.0005). The average amount of pectin taken was 12.7 g/day in patients who relapsed and 12.4 g/day in those who did not. At the doses taken, therefore, dietary supplementation with pectin did not reduce the incidence of duodenal ulcer relapse.