Naruaki Kohge

Expression rate of cytokine mRNA in the liver of chronic hepatitis C: comparison with chronic hepatitis B.

This study was carried out to test the hypothesis that, in chronic hepatitis (CH), inflammatory processes, including viral replication, host immune response, and hepatocyte destruction, are regulated by a cytokine network in the liver. Expression of the mRNA of the cytokines IL1-beta, IL2, IL4, IL5, IL6, TNF-alpha, and IFN-gamma, the lymphocyte markers CD4 and CD8, and the HLA class I molecule, beta 2-microglobulin (B2MG) in the liver tissue of 20 CH(C) cases and 9 CH(B) patients was investigated by the reverse transcription polymerase chain reaction (RT-PCR) method. TNF-alpha, CD4, and B2MG mRNA were detected in 100% of cases of in both CH(B) and CH(C). The expression rates of IL1-beta, IL2, IL4, IFN-gamma, and CD8 mRNA were 80%, 40%, 25%, 40%, and 80% in CH(C) and 88.9%, 44.5%, 30%, 55.6%, and 100% in CH(B). IL6 mRNA was detected only in CH(B), in 22.2% of cases, IL5 mRNA was not detected in either CH(B) or CH(C). IL2, IL4, and IFN-gamma mRNA were expressed significantly more frequently in patients who had high serum ALT and a high histological activity index (HAI) score. There was no difference in cytokine expression between CH(B) and CH(C), except in IL6, suggesting the existence of a common immunopathogenesis for CH(B) and CH(C). In chronic viral hepatitis, IL1-beta and TNF-alpha appear to play a major role in immune responses and IL2, IL4, and IFN-gamma seem to be associated with increased cytotoxic T cell response. Our results give partial support to the hypothesis that the cytokine network is important in the inflammatory process in chronic viral hepatitis in vivo.

Ulinastatin shows preventive effect on post-endoscopic retrograde cholangiopancreatography pancreatitis in a multicenter prospective randomized study

Background and Aim:  Endoscopic retrograde cholangiopancreatography (ERCP) is a useful diagnostic and therapeutic procedure; however, ERCP occasionally causes post‐ERCP pancreatitis. The administration of gabexate mesilate has been reported to be effective for the prevention for post‐ERCP pancreatitis when given during and after the procedure. The aim of the present study was to investigate the preventive effect of the novel protease inhibitor ulinastatin on post‐ERCP pancreatitis.

Congenital anomalies in a child born from a mother with interferon-treated chronic hepatitis B

refused to participate was male) and 12/13 (92%) were anorexic. The patients had a median age of 26 yr. Eight patients (62%) had sought out a gastroenterologist or primary care physician with a GI complaint. Of these eight patients, six (46%) had sought treatment for their GI complaintsbefore ever seeking treatment for their eating disorder.Five patients (38%) had had an endoscopy, an upper GI barium contrast radiograph, or a lower GI barium contrast radiograph. Six patients (46%) had been prescribed some form of medication for a GI problem. Seven of the patients (54%) experienced frequent heartburn or reflux. They experienced these symptoms an average of 2.7 times/day. Six of the patients had a history of laxative abuse. All of these patients had previously sought help for a GI problem. Gastroenterologists would serve their patients well by learning the early signs and symptoms of anorexia and bulimia. Because they are in a unique position to make an early diagnosis, they can refer these patients in a timely fashion to mental health professionals who specialize in the treatment of eating disorders. The earlier these problems are treated, the better the prognosis. Our study also suggests that gastroenterologists would benefit their patients by learning the signs and symptoms of surreptitious laxative abuse. A series of open-ended questions for the initial interview of patients suspected of anorexia or bulimia has been advocated and could be useful not only for this patient population, but for all young, female patients if used routinely (6). Clearly, further studies are warranted to confirm and expand these findings. We propose an ongoing follow-up study to survey 100 consecutive inpatients on the eating disorders unit. The study should include a control group to determine the incidence of similar physician visits by an ageand sex-matched population. Our hypothesis is that a matched control group would have a significantly lower incidence of visits to a gastroenterologist than would a population of eating-disordered patients.

Report of a case showing a recovery from liver cirrhosis to chronic hepatitis, type C, after glycyrrhizin injection for 2 years and a sustained response by the following interferon therapy.

TO THE EDITOR: We read with great interest the article recently published by Schepke et al. (1), which demonstrates that Doppler assessment of portal vein flow velocity allows an accurate distinction between responders and nonresponders to propranolol acute administration compared with hemodynamic assessment. This is an important step in the field of treatment of portal hypertension, because hemodynamic evaluation is a relatively safe but still invasive technique and not as available as Doppler. At the end of the article the authors advocate the need for studies correlating Doppler parameters with clinical endpoints such as variceal bleeding. We here remark on our experience in this field. On the basis of a previous study, demonstrating a peak effect on portal flow velocity between 2 and 4 h after administration of 40 mg p.o. of propranolol (2), we conducted a prospective study on cirrhotic patients with esophageal varices at high risk of bleeding. This study, presented in the 49th ASSLD meeting in 1998 and published in 1999 (3), demonstrated that the portal flow velocity test was a safe and feasible method to predict the efficacy of b blockers in the prevention of a first variceal bleeding. A

The role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding

12% decrease in maximal portal flow velocity after propranolol acute administration was the best cutoff value with respect to efficacy of subsequent chronic treatment in preventing variceal bleeding, with a sensitivity of 69% and a specificity of 70%. Notwithstanding some methodological problems, our findings, also discussed by Garcia-Tsao (4), are clinically relevant and find further scientific support in Schepke et al.’s data. The slight difference between the cutoff point values reported in the two studies may be the consequence of the different endpoints and of operator and technical factors. It should be mentioned that the mean acute variation in portal flow velocity after the administration of b blocker reported in the literature ranges from 211.2% to 220.4% (5). We propose that the portal flow velocity test be used for response to propranolol administration before starting chronic therapy. If there is not a significant decrease in maximal portal flow velocity, the patient is a nonresponder and will not derive any clinical benefit, so the clinician should supplement or change the therapeutic approach.

Spontaneous Resolution of Chronic Hepatitis C – A Case Report

Multi‐detector‐row computed tomography (MDCT) has been reported to be a potentially useful modality for detection of the bleeding origin in patients with acute upper massive gastrointestinal (GI) bleeding. The purpose of this study is to investigate the efficacy of MDCT as a routine method for detecting the origin of acute upper GI bleeding prior to urgent endoscopy.

Inflammation of the liver causes mutations in duck hepatitis B virus genome

We experienced a case of chronic hepatitis C showing spontaneous resolution. The patient was diagnosed as having chronic hepatitis with moderate activity, non‐A non‐B type, after laparoscopy with liver histology in 1982, and was followed up thereafter at our out‐patient clinic. His aspartate aminotransferase (AST)and alanine aminotransferase (ALT) levels fluctuated but had stabilized by 1990.

Role of Laparoscopy in the Diagnosis of Pancreatic Cancer

SummaryTo investigate whether hepatitis causes mutation in the viral genome, DNA sequences in the pre-core region of duck hepatitis B virus (DHBV) DNA were analyzed in both ducks with hepatitis and without hepatitis. Five DHBV carrier ducks were injected with DHBV particle proteins purified from duck serum with Freund’s complete adjuvant (FCA) intrahepatically from 14 day posthatch for 9 weeks (immunized group). Serum was drawn at the end of the 1st and 4th week after the 1st injection of DHBV particle protein and ducks were killed at the end of the 9th week to obtain the liver. Another five ducks without treatment were used as controls. All ducks of the immunized group showed moderate to severe hepatitis at the 9th week. All ducks in the immunized group showed one mutation except one duck that showed two mutations only at the 9th week. Mutations were observed in the 5th, 13th, 21st, 22nd, and 28th codon of the precore region. All of them were point mutation at the 3rd base in the triplets. The frequency of mutation was different in each duck from 20% to 60% but not 100%. There was no mutations in ducks in control group. These results suggest that hepatitis causes mutation in the pre-core lesion genome of duck hepatitis B virus.

Endoscopic submucosal dissection of early gastric cancer via inverted overtube in a patient with situs inversus totalis: a case report

Abstract: The role of laparoscopy in the diagnosis of pancreatic cancer was evaluated. Twenty two patients who were suspected of having pancreatic cancer, following physical examination, laboratory tests, and imaging techniques, received a laparoscopy at our clinic. The laparoscopic and histological findings were analyzed retrospectively. Eighteen patients in whom the pancreas was observed were laparoscopically diagnosed as having pancreatic cancer, and one other patient from a laparoscopic ultrasonography. Among 14 patients in whom a direct forceps biopsy of the pancreas was done, pancreatic tissue was obtained from 11 patients (78.6%) and cancer was histologically proven in only 3. Liver metastasis were observed in 11 patients, among whom an aimed biopsy to the hepatic lesion was done in 10, and adenocarcinoma was histologically proven in all of these patients. Peritonitis carcinomatosa was confirmed in 4 patients and adenocarcinorna was proven in all of the patients by histology after a punch biopsy to the lesion. Thus, histological evidence of cancer was obtained in 13 out of the 22 patients studied (59.1%).

The Accuracy of a Non-Invasive Liver Fibrosis Evaluation Method, Shear WaveElastography: A Retrospective Pilot Study

Background and study aims  A 72-year-old man with complete situs inversus presented with early gastric cancer on the lesser curvature wall of the antrum of the stomach. Endoscopic submucosal dissection (ESD) was selected as a treatment. When the patient was positioned in the left decubitus position, the lesion was hidden by blood and gastric fluid because it was located on the gravitational side. Therefore, we decided to perform ESD with the patient in the right lateral decubitus position and use an inverted overtube, which provided a good endoscopic view without the need to rearrange the endoscopist, assistants, or endoscopic system. ESD was safe and feasible using the inverted overtube.