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A 43-year-old Japanese Bolivian male had been suffering from a right leg ulcer after an insect bite during his residence in Bolivia. The ulcer healed after herbal medicine treatment. Ten years later, the patient had symptoms of nasal obstruction, nasal bleeding, and pharyngodynia, which were accompanied by a destructive ulcer with surrounding erythema involving the right nostril apex and columella. Papillary, irregular mucosal lesions were seen on the soft palate. Giemsa staining and polymerase chain reaction (PCR) using biopsy specimens of the papillary mucosal lesions on the soft palate failed to identify Leishmania parasites. However, the IgG antibody test was positive for Leishmania (Leishmania) donovani, and the dot enzyme-linked immunosorbent assay (dot-ELISA) using five Leishmania antigens L. (L.) mexicana, L. (L.) amazonensis, Leishmania (Viannia) guyanensis, L. (V.) braziliensis, and L. (V.) panamensis was positive. Combined, the findings suggested mucocutaneous leishmaniasis. Treatment with liposomal amphotericin B was started but was soon terminated because of palpitation, epigastralgia and facial flushing. It is sometimes difficult to identify the parasites in lesions of mucocutaneous leishmaniasis and serological tests are useful for such occasions. [ABSTRACT FROM AUTHOR]

Abstract: Pigmentation in avian eggshells appears to be associated with shell strength, temperature regulation, and camouflage. The pigments found in eggshells are mainly porphyrins, which have been utilized therapeutically as photosensitizers. Here, we examined the photoinactivation of gram-positive (Staphylococcus aureus, Bacillus cereus) and gram-negative bacteria (Escherichia coli, Salmonella enteritidis) by hen eggshells and their pigments. The results indicated that eggshells have a light-dependent antimicrobial activity against gram-positive, but not gram-negative, bacteria. Our results indicate the possibility that the natural pigments used therapeutically have evolved in nature as a defence system. [Copyright &y& Elsevier]

A 74-year-old woman was transferred to our hospital for further examinations because of abdominal fullness and abnormal levels of serum liver/biliary enzyme persisting for 3 weeks. She had anemia and dilatation of many capillary vessels in her fingers, palms, and tongue in addition to reporting frequent incidences of nasal bleeding in herself and her family. Abdominal ultrasonography detected a cystic lesion in the right hepatic lobe, connected to a dilated tortuous hepatic artery. A low-echoic hepatic phyma was also detected in the back of the cystic lesion. Abdominal computed tomography and magnetic resonance imaging indicated that the cystic lesion was an aneurysm and the low-echoic phyma was a hematoma. Hepatic arteriography confirmed a hepatic aneurysm, tortuous dilatation of the hepatic artery, and the complication of an arteriovenous shunt in the liver. Taking all of these findings into consideration, this case was diagnosed as hereditary hemorrhagic telangiectasia (HTT) complicated by a hepatic aneurysm causing intrahepatic hematoma. To prevent re-rupture of the aneurysm, we performed a hepatic arterial coil embolization. After therapy, no blood flow to the aneurysm was detected by ultrasonic color Doppler method and the hematoma gradually diminished. There have been no reports of a case in which hepatic arterial embolization was effective for HHT-associated hepatic aneurysm causing intrahepatic hematoma. This very rare case provides important clinical information regarding abdominal vascular complications of HTT and a less invasive treatment for them. [ABSTRACT FROM AUTHOR]

The composition of the molecular species of triacylglycerols (TG) in subcutaneous fat biopsied from Japanese Black steers was studied during the fattening period. An analysis of the fatty acid (FA) composition of the TG showed that palmitic, palmitoleic, stearic and oleic acids were the major FA, together accounting for over 80% of the total FA. The concentrations of C14:0, C16:0 and C18:0 decreased between 10 and 30 months of age, while those of C16:1 c9 and C18:1 c9 increased during the fattening period. The major molecular species among more than 40 compounds were palmitoyl-dioleoyl-glycerol (POO) and dipalmitoyl-oleoyl-glycerol (PPO). POO showed the highest concentration during the fattening period. The levels of palmitoyl-oleoyl-linoleoyl glycerol and some tentatively identified molecular species increased during the fattening period, while the levels of tripalmitoyl, dipalmitoyl-stearoyl-glycerol, palmitoyl-distearoyl and palmitoyl-stearoyl-oleoyl-glycerol decreased with growth. A comparison of the experimental values of TG molecular species with theoretical values derived from the experimental FA contents showed that the FA distribution in TG was non-random. TG synthesis favors the formation of TG molecular species containing at least one C16 FA, rather than three C18 FA. [ABSTRACT FROM AUTHOR]

To determine the effect of bacteria on the development of the ripening flavor of cured meat, pork loins were cured with pickles containing 8 or 16% sodium chloride at 0 and 8°C. The bacterial flora, total free amino acid content and total free fatty acid content in the cured loins, sensory properties of cooked pork loins and the relationships between the proteolytic and lipolytic activities of isolates and curing conditions were investigated. Desirable bacteria, including salt-tolerant bacteria and lactic acid bacteria, were predominant under the condition of 8% sodium chloride in the pickles and a curing temperature of 8°C. The total free amino acid content and total free fatty acid content at a curing temperature of 8°C were higher than those at 0°C. Cooked pork loins cured in pickles containing 8% sodium chloride at a temperature of 8°C for more than 7 days were preferred in terms of color, flavor and taste. Before the curing procedure, gram-negative bacteria ( Vibrio, Acinetobacter, Pseudomonas and Enterobacteriaceae) were predominant in the pork loins. During the curing period, the numbers of viable gram-positive bacteria ( Micrococcus, Staphylococcus and Pediococcus) increased and the numbers of viable gram-negative bacteria decreased. Strains of Micrococcus and Staphylococcus with proteolytic and/or lipolytic activities in cured meat also increased during the curing period and were more predominant in the pork loins cured in pickles containing 8% sodium chloride and at a curing temperature of 8°C than in pork loins cured in pickles containing 16% sodium chloride and at a curing temperature of 0°C. The actions of these bacteria were thought to be important factors affecting the flavor of the cured pork. Micrococcus and Staphylococcus with proteolytic activity might contribute to the development of the ripening flavor of ham. The results of the present study together with the results of further investigations on the relationships of the enzyme activities of Micrococcus and Staphylococcus in cured meat with a preferable flavor would be useful for establishing a novel effective method for using bacteria to produce ham of a high quality. [ABSTRACT FROM AUTHOR]

It has previously been reported that there is a strong correlation between the expression of glycosylphosphatidylinositol (GPI)-anchored complement membrane inhibitor in gastric epithelium and the severity of inflammation of gastric mucosa. To investigate the regulation of complement activity in gastric epithelium during Helicobacter pylori ( H. pylori)-associated gastritis, the expression of GPI-anchored complement membrane inhibitors, decay-accelerating factor (DAF) and 20-kDa homologous restriction factor 20 (HRF20), and membrane cofactor protein (MCP), which is a transmembrane protein, were evaluated after removal of the H. pylori stimulus. Furthermore, the expression of the complement fragment, C3c, was also investigated. Forty-six patients with epigastric symptoms and endoscopically confirmed peptic ulcer or gastritis who had H. pylori infection of the gastric mucosa were enrolled in the present study. Biopsy specimens were obtained from the gastric antrum and corpus 1 month before and after eradication. Helicobacter pylori infection was determined by the rapid urease test, histology, and culture before eradication, and by histology, culture, and urea breath test after eradication. Gastric biopsy specimens obtained before and after eradication were evaluated for infiltration by neutrophils and mononuclear cells. The expression of complement membrane inhibitors, DAF, HRF20, and MCP and that of the main complement fragment, C3c, was immunohistochemically evaluated. One month after the eradication of H. pylori, the infiltration by neutrophils and mononuclear cells in the gastric mucosa decreased significantly ( P < 0.0001) as compared with that before eradication. The expression of DAF, HRF20, and C3c on gastric mucosal epithelium also significantly decreased in both the antrum and the corpus ( P < 0.05) 1 month after eradication. However, no change was observed in the expression of MCP. The decrease in the expression of GPI-anchored complement regulator and the complement after removal of a chronic microbial stimulus suggests that the gastric epithelium appears to undergo an aggressive stress of complement during H. pylori infection. Conclusively, DAF and HRF20 may play an important protective role against complement-mediated damage induced by chronic microbial stimuli in such a pathological condition. [ABSTRACT FROM AUTHOR]

The prevalence of Helicobacter pylori ( Hp) infection and the development of gastric cancer are both believed to increase with age in Japan. However, no studies have investigated people older than 65 years in detail. In this study, we investigated the prevalence of Hp infection and gastric cancer in the elderly, and analyzed the influence of both factors on longevity. All patients investigated were 65 years old and over. A total of 1877 autopsy cases were used to investigate the prevalence of gastric cancer and colonic cancer. Serum samples were obtained from 644 patients with dyspepsia and analyzed for Hp-IgG antibodies. Of these 644 patients, 63 underwent upper gastrointestinal endoscopies. Five biopsies were obtained and evaluated for the following morphological variables: neutrophils, mononuclear cell, atrophy, and intestinal metaplasia. Hp infection was evaluated histologically and with the 13C-urea breath test. The prevalence of gastric cancer was significantly lower in subjects older than 85 years. The positive rate of serum Hp-IgG, and Hp infection as detected histologically and by the 13C-urea breath test, also decreased with age. In Hp(+) patients, the neutrophil score significantly decreased with age. In Hp(–) patients, however, the intestinal metaplasia score significantly increased with age. The non-infection of Hp itself is not related to longevity in Japanese elderly, because even Hp(–) patients appear to have been infected previously with Hp. The lower prevalence of gastric cancer in the elderly may be due to the disappearance of Hp colonization, which may contribute to longevity in Japanese elderly. © 2005 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]

The innocuous pure recombinant cholera toxin B-subunit (rCTB) is very attractive as a strong adjuvant for host immunization, but little is known about rCTB's gastric mucosal immunoadjuvanticity against Helicobacter pylori. The immunoadjuvanticity of rCTB against H. pylori was tested. Mice were immunized with sonicated H. pylori and rCTB orally or intranasally and sacrificed on day 42 after immunization. Passive cutaneous anaphylaxis (PCA) test was performed to evaluate IgE-mediated anaphylaxis with serum from mice to which H. pylori-antigen with rCTB had been administered. Immunoglobulin titer specific to H. pylori in serum, lavation of the gastrointestinal tracts and feces were examined. Gastritis in vaccinated mice after a challenge was assessed with the scoring defined from grading of gastric inflammation. H. pylori proliferation after immunization was investigated by counting colony forming units (CFU) per gram of stomach tissue. PCA test exhibited no reactions against the serum from mice immunized with H. pylori-antigen with rCTB administered orally and intranasally. Oral and nasal coadministrations of rCTB significantly raised systemic and mucosal immunities against H. pylori and suppressed proliferation of H. pylori in gastric mucosa. The score of gastritis in mice immunized orally was significantly higher than that of mice immunized nasally due to postimmunization gastritis. Only oral administration of rCTB suppressed H. pylori proliferation as compared with intranasal administration and without rCTB. The present study indicated that rCTB has systemic and mucosal immunoadjuvanticities against H. pylori and that oral vaccination with rCTB might additively support antibiotic eradication. [ABSTRACT FROM AUTHOR]

Covered self-expandable metallic stent (SEMS) prevents tumor ingrowth and hyperplasia, and allows long-term patency. However, covered SEMS has rarely been used for malignant duodenal obstruction. In the present study, we applied a covered SEMS for malignant duodenal obstruction, aiming at prevention of tumor ingrowth and hyperplasia and long-term patency, and performed clinical evaluation. The original disease was pancreas cancer in 23 patients, gallbladder cancer in two, bile duct cancer in two, Vater's papilla cancer in one, duodenal cancer in two, and metastatic tumor (uterine cancer) in one. Treatment of duodenal obstruction using a covered SEMS was successful in 30 of the 31 patients. The patients were able to ingest orally within a mean of 2 days, and 90% of the patients (27/30) were able to eat solid diets later. None of the patients reported a symptom due to obstruction of the SEMS until death. The mean duration of patency of the duodenal covered SEMS was 175 days (SD:± 114 days). We concluded that palliative thrapy using a covered SEMS for malignant duodenal obstruction obtained good patency and it was useful thrapy. [ABSTRACT FROM AUTHOR]

Gastric atrophy induced byHelicobacter pyloriis thought to predispose patients to noncardiac gastric cancer development. However, the host genetic factors that influence the progression of gastric atrophy have not been elucidated. In this study, we examined the effects of cytokine polymorphisms onH. pylori-induced gastric atrophy.Blood samples were taken from 454 Japanese subjects. The interleukin-2 (IL-2; T-330G), IL-4 (C-33T), and IL-13 (C-1111T) polymorphisms were genotyped by polymerase chain reaction with confronting two-pair primers (PCR-CTPP). Anti-H. pyloriIgG antibody and pepsinogen I and II were measured to diagnoseH. pyloriinfection and atrophic gastritis.The odds ratios (ORs) for the association betweenIL-2polymorphism[OR = 2.78, 95% CI (confidence interval) = 1.26–6.17 (T/T to G/G)] orIL-4polymorphism[OR = 2.22, 95% CI = 1.01–4.89 (T/C to C/C)] were increased significantly with gastric atrophy, whereas the corresponding OR of IL-13 polymorphism was decreased with gastric atrophy[OR = 0.61, 95% CI = 0.39–0.96 (C/T and T/T to C/C)]. There were no significantH. pyloriseropositivity-related differences between these polymorphisms. We examined the relationship between these polymorphisms and gastric atrophy separately inH. pylori-seropositive and -seronegative groups. In theH. pylori-seropositive group, the IL-2 T/T (OR = 2.78, 95% CI = 1.12–6.93) had a significant association with gastric atrophy.These results reveal that the IL-2 gene polymorphism is associated with an increased risk of gastric atrophy induced byH. pyloriinfection and might predispose to gastric cancer. [ABSTRACT FROM AUTHOR]

Abstract: A prognostic estimation formula of acute liver damage was evaluated by using clinical data and technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) scintigraphy in order to determine operability for orthotopic liver transplantation (OLT). Forty-six patients hospitalized for acute liver damage were divided into survival (n =35) and non-survival (n =11) groups. Univariate and multivariate analyses were used to identify significant factors that affected prognosis. Logistic regression analysis was performed to predict prognosis with effective factors. Ten independent factors with significant differences were identified and further analyzed for significance by logistic regression analysis. Among the 10 factors, age and LHL15/HH15 were identified as having meaningful differences for predicting convalescence. The following formula was developed: A negative value for R indicates non-survivals, and a positive value indicates survivals. The mortality rate was calculated as=1/(1+ e R ). The sensitivity was 0.909, specificity was 1.000, and accuracy was 0.978. The reliability of this formula was as good as that of another formula presented previously by the Intractable Liver Diseases Study Group of Japan. The use of 99mTc-GSA for estimating the prognosis of acute liver damage is useful, especially before the onset of hepatic encephalopathy. [Copyright &y& Elsevier]

The p53 binding protein 2 (53BP2) has been identified as the interacting protein to p53, Bcl-2, and p65 subunit of nuclear factorκB (NF-κB). The TP53BP2 gene encodes two splicing variants, 53BP2S and 53BP2L, previously known as apoptosis stimulating protein 2 of p53 (ASPP2). We found that these 53BP2 proteins are located predominantly in the cytoplasm and induce apoptosis as demonstrated by cleavage of poly ADP ribose polymerase (PARP) and annexin V staining. Furthermore, we demonstrate that 53BP2 is located in the mitochondria and induces apoptosis associated with depression of the mitochondrial trans-membrane potential (ΔΨm) and activation of caspase-9. From these findings we conclude that 53BP2 induces apoptosis through the mitochondrial death pathway. [ABSTRACT FROM AUTHOR]

A 37-year-old man presented complaining of epigastralgia. Abdominal ultrasonography revealed the presence of a papillary tumor (9 mm in diameter) in the cystic lesion (18 mm in diameter) in hepatic segment 4, which was accompanied by mild intrahepatic bile duct dilatation. Although abdominal computed tomography also showed the cystic lesion, it did not show papillary tumors inside the lesion. Endoscopic retrograde cholangiography showed the communication between the cystic lesion and the left hepatic duct. In addition, mucus was observed in the common bile duct. When transpapillary intraductal ultrasonography was performed through the left hepatic duct using a fine ultrasonic probe, a hyperechoic papillary and lobulated tumor was clearly shown in the cystic lesion. The wall of the cyst was smooth and there was no sign of tumor infiltration. Based on these findings, biliary cystadenoma was diagnosed and an extended left lobectomy was carried out. However, pathological findings postoperatively revealed that the lesion was a localized biliary papilloma, developing and extending to the intrahepatic duct. This case is rare and there have been no published reports describing a biliary papilloma morphologically similar to biliary cystadenoma. [ABSTRACT FROM AUTHOR]

We report an autoimmune pancreatitis case with diverse manifestation of biliary stricture, lung fibrosis and immune thrombocytopenic purpura. The patient was a 70-year-old man who presented with jaundice. Abdominal ultrasonography and computed tomography revealed enlargement of the entire pancreas and endoscopic retrograde pancreatography showed diffuse irregular narrowing of the main pancreatic duct. Endoscopic retrograde cholangiography revealed a band-like stricture of the bile duct in the hilar hepatic region with intrahepatic duct dilation. Chest X-rays and computed tomography revealed interstitial fibrosis of the bilateral lower lungs. Thrombocytopenia and purpura appeared. Antinuclear antibody, anti-Ro (SS-A) and anti-La (SS-B) antibodies and rheumatoid factor were positive. All manifestations responded well to steroid therapy. From the present case it would appear that a multitude of manifestations are linked within one syndrome. If we encounter patients with autoimmune pancreatitis, we should not focus on a disease but rather on the possibility of a syndrome complex. [ABSTRACT FROM AUTHOR]

It has previously been reported that Cdx2 is the useful prognostic and intestinal phenotypic marker in advanced gastric cancers (GC). In this study, Cdx2 expression and phenotype in early GC and non-neoplastic surrounding mucosa were examined. A total of 130 early GC (70 intramucosal and 60 submucosally invasive cancers) histologically and phenotypically were evaluated. The expression of Cdx2 was assessed by immunohistochemistry. The lesions were phenotypically divided into 44 gastric (G), 42 gastric and intestinal mixed (GI), 30 intestinal (I), and 14 null (N) types, independent of the histological classification. Most of the early GC were Cdx2-positive, nuclear staining being strongly associated with intestinal phenotypic expression. Early differentiated cancers tended to feature both Cdx2 and intestinal phenotypic expression, while their undifferentiated counterparts were more likely to demonstrate only gastric phenotypic expression ( P < 0.05). The phenotypes of six intramucosal microcarcinomas did not correlate with those of adjacent normal glands. These data suggest that Cdx2 is expressed in the very early stage of gastric carcinogenesis in association with the shift from gastric to intestinal phenotypic expression. This appears to occur in differentiated cancers at an earlier stage than in undifferentiated ones, and may be linked to suppression of expansion of malignant cells. [ABSTRACT FROM AUTHOR]

Background and aim Many lines of evidence indicate that hyperinsulinemia might be associated with coronary athrosclerosis, and, currently, there are no effective strategies for preventing this. We previously reported that high insulin enhances neutrophil-transendothelial migration, a process that involves increased surface presentation of platelet endothelial cell adhesion molecule-1 (PECAM-1) through a mitogen-activated protein (MAP) kinase-dependent event. In this current study, we examined if antidiabetic agents, especially KATP channel blockers, might similarly protect against the leukocyte-endothelial cell interactions enhanced by high insulin. Methods Neutrophils transmigration across umbilical vein endothelial cells (in high insulin medium) with or without KATP channel blockers was performed. Neutrophil migration was quantified by measuring myeloperoxidase, and surface expression of endothelial PECAM-1 was examined using cell-surface enzyme immunoassay. Results Neutrophil-transendothelial migration and PECAM-1 expression were enhanced by insulin (100 µU/mL, 24 h) and were attenuated by gliclazide (20 µM), but not by other KATP channel blockers (glibenclamide, nateglinide, and glimepiride). Neutrophil migration and PECAM-1 expression were also increased by the mitogen-activated protein (MAP) kinase activator, anisomycin (1 µM), and also attenuated by gliclazide. Nitric oxide (NO) synthase inhibitors did not modify either gliclazide effect. Conclusions Our results suggest that the KATP channel blocker, gliclazide, blocks high insulin-mediated neutrophil migration and PECAM-1 expression. These gliclazide effects may be mediated through the inhibition of MAP kinase activation and are unrelated to NO production. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The present study was performed to evaluate the usefulness of the Memory® 8-wire basket forceps for extracting small common bile duct stones after endoscopic sphincterotomy (EST). Sixty-one patients with common bile duct stones underwent EST. In patients with stones of 1 cm or more diameter, stones were crushed into fragments having a diameter of less than 1 cm using a mechanical lithotriptor. Stones were extracted using a conventional 4-wire basket forceps and a stone retrieval balloon catheter. After endoscopic and fluoroscopic confirmation of the absence of stones, stone extraction was again attempted using the Memory® 8-wire basket forceps, which consists of a 5 Fr catheter sheath and a helical 8-wire nitinol monofilament basket. After a few days, the presence or absence of residual stones was examined by cholangiography via the endoscopic nasobiliary drainage tube. Further extraction of stones was possible using the Memory® 8-wire basket forceps in 47.5% (29/61) of the patients who underwent extraction of stones by a 4 wire-basket forceps and a stone retrieval balloon catheter. Cholangiography some days after using the Memory® 8-wire basket forceps showed residual stones in only two patients (3.3%). The Memory® 8-wire basket forceps was a useful device for the accurate and rapid endoscopic extraction of common bile duct stones with a diameter of less than 1 cm after EST. [ABSTRACT FROM AUTHOR]

Endoscopic bilateral expandable metal stent (EMS) placement has been performed in malignant hilar strictures. To perform EMS placement successfully, insertion of guidewires into the bilateral intrahepatic bile ducts is an important and necessary step. In the present study, we evaluated the usefulness of the Haber RAMPTM catheter (HRC) for the selective insertion of guidewires. EMS placement was performed in 17 patients with malignant hilar strictures. As the HRC has three lumens connected to apertures facing in different directions, the direction of the guidewire can be controlled at the catheter tip. Insertion of guidewires into bilateral intrahepatic bile ducts was attempted with and without the HRC. The success rate of guidewire insertion into the bilateral intrahepatic bile ducts was 100% (7/7) when the HRC was used, whereas it was 50% (5/10) without the HRC. In the five patients with insertion failure, reinsertion was successfully performed using the HRC. The time required for the bilateral insertion of guidewires was reduced using the HRC. Bilateral EMSs placement was successful in 14 of the 17 patients (82%). The HRC was very useful for the accurate and rapid bilateral insertion of guidewires. [ABSTRACT FROM AUTHOR]

Abstract Background and Aim: It is well known that capsaicin-sensitive nerve signaling acts as a protective factor against various ulcerogens. However, the contribution of topical capsaicin-sensitive nerves within the stomach to rapid restitution has not been fully investigated. The present study was therefore conducted focusing on recovery from gastric mucosal damage induced by ethanol in vivo . Methods: Male Sprague-Dawley rats were fasted and anesthetized. [sup 51] Cr-EDTA was administered intravenously and gastric mucosal integrity was continuously monitored by measuring the blood to lumen [sup 51] Cr-EDTA clearance. Capsaicin or vehicle was irrigated before, together with or after the perfusion of 20% ethanol, followed by perfusion with saline. In another experiment, ruthenium red, a capsaicin-sensitive cation antagonist, was given before the ethanol-capsaicin perfusion. Furthermore, this study was verified using lafutidine, a histamine H[sub 2] -receptor antagonist, which has a gastric mucosal protective action through the capsaicin-sensitive afferent nerves. Results: When capsaicin was administered before ethanol treatment, mucosal damage was significantly reduced and recovery was significantly rapid compared to the control. When capsaicin (160 µM) and ethanol were administered simultaneously, the mucosal damage was exacerbated but recovery was nevertheless more rapid than the control group. With a lower dose of capsaicin (80 µM), mucosal damage was not exacerbated and recovery was enhanced. When capsaicin or lafutidine was administered after the induction of ethanol injury no change was detected regarding the damage. However, recovery was significantly accelerated. Ruthenium red reversed the action of post-treatment with capsaicin on restitution. Conclusions: These results indicate that luminal administration of capsaicin exerts protection against and accelerates restitution from gastric damage in the very early phase after ethanol injury. This action is probably due to activation of topical capsaicin-sensitive afferent nerves in the rat. [ABSTRACT FROM AUTHOR]

Five patients with non-resectable pancreatic head carcinoma complicated by duodenal and biliary obstructions were successfully treated by double stenting with covered self-expandable metallic stents (EMS). Diamond (Boston Scientific, Natick City, MA, USA) stents covered with a polyurethane membrane were used to treat biliary obstructions, whereas covered Ultraflex (Boston Scientific) stents for esophageal stenting were used to treat duodenal obstructions. That is, Diamond stents were initially placed in the biliary tract percutaneously in one patient and endoscopically in the remaining four patients. Subsequently, covered Ultraflex stents were placed in the duodenum. Double stenting with EMS was successfully performed in all five patients without inducing early technical complications. All patients were able to take a liquid diet orally at a mean 1.6 days after the double stenting procedure and were able to eat solid foods thereafter. Sludge-induced biliary obstructions were detected in two patients 3 and 6 months after the placement of EMS. However, recurrent biliary obstruction was not noted in the remaining three patients. The EMS left in the duodenum were not obstructed during the observation period. The survival period of the patients ranged from 86 to 363 days (mean 172 days). There have not been any reports evaluating the usefulness of double stenting using covered EMS for duodenal and biliary obstructions. Because favorable results were obtained by double stenting in our patients, stenting for duodenal and biliary obstructions caused by non-resectable pancreatic head carcinoma may become a useful treatment modality substituting for bypass surgery. [ABSTRACT FROM AUTHOR]

A 50-year-old male received conservative medical treatment for acute exacerbation of chronic pancreatitis. High fever, abdominal pain, as well as enhancement of inflammatory response and pancreatic enzymes in serum, persisted after treatment for 1 month. Purulent pancreatic fluid was drained by endoscopically placing an 8F plastic stent in the main pancreatic duct, resulting in marked improvement of clinical symptoms. This case appears to provide useful information in considering indications for pancreatic stents. [ABSTRACT FROM AUTHOR]

We have reported successful implantation of self-expandable metallic stents for palliative treatment in a case of an 87-year-old female patient with carcinoma of the papilla of Vater. She suffered from both duodenal and biliary stenoses, but refused surgical treatment. For the duodenal stenting, a self-expandable knitted nitinol metallic stent, for esophageal use, was inserted endoscopically. For the biliary stenting, a self-expandable metallic stent, partially polyurethane-covered on the proximal part to prevent tumor ingrowth and overgrowth, was inserted via the percutaneous transhepatic biliary drainage route. No major complications occured during these procedures. After the two stents were inserted in an end-to-side fashion, she was able to eat a normal diet adequately and suffered from no abdominal symptoms and jaundice during the follow-up period of 13 months. These stenting procedures might be less invasive and more useful than surgical treatment and provide long patency of biliary stenting and a good quality of life. [ABSTRACT FROM AUTHOR]

AbstractBackground: The role of complement in ischaemia–reperfusion injury has not been well investigated. 5I2 is a monoclonal antibody (mAb) directed against a rat membrane inhibitor of the C3 convertase step, which is the rat counterpart of mouse Crry/p65. 6D1 is a mAb against rat CD59 which inhibits the formation of membrane attack complexes. Methods: We visualized the tissue distribution of these membrane inhibitors in rat gastrointestinal tract by immunohistochemical staining with the appropriate mAb. Then, we tested the hypothesis that complement regulatory proteins protect rat gastric mucosa against ischaemia–reperfusion stress by using these mAbs. Gastric mucosal integrity was continuously monitored by measuring the blood-to-lumen clearance of [51Cr]-labelled ethylenediaminetetraacetic acid (EDTA) under control conditions, during ischaemia and after reperfusion. Results: Rat 6D1 and 5I2 antigens were both widely distributed and predominantly expressed on smooth muscle and endothelial cells in gastrointestinal tracts. Blockade of complement regulatory proteins with 5I2 and 6D1 mAbs resulted in a significant increase in [51Cr]-EDTA clearance after reperfusion. Conclusions: These findings support the hypothesis that endogenous complement regulatory proteins may act as important protective factors against ischaemia–reperfusion stress in rat gastric mucosa. © 1999 Blackwell Science Asia Pty Ltd. [ABSTRACT FROM AUTHOR]

Background and Aims: The purpose of this study was to clarify the value and limitation of imaging modalities for diagnosing small hepatocellular carcinoma (HCC). Methods: Nodules (n = 207) with diameters of 20 mm or less detected by periodic ultrasonography and computed tomography in 139 patients with chronic liver disease were investigated with digital subtraction angiography (DSA) and magnetic resonance imaging (MRI). These findings were compared with histological findings. Results: Histological diagnoses were adenomatous hyperplasia (AH, n = 27), well-differentiated HCC (n = 99), moderately differentiated HCC (n = 79) and poorly differentiated HCC (n = 2). We compared two groups: group A (n = 62), nodules of 10 mm diameters or less; and group B (n = 145), nodules 11–20 mm. Adenomatous hyperplasia accounted for approximately 30% of group A, but was difficult to diagnose with imaging modalities alone. We diagnosed those nodules showing hypervascular staining on DSA or hyperintensity on MRI T2-weighted images as HCC. Imaging alone was sufficient to diagnose HCC in 58% of the well-differentiated nodules and 87% of the moderately and poorly differentiated nodules (P < 0.01). It was possible to diagnose HCC by imaging alone in 60% of all nodules or 45% of group A and 68% of group B (A vs B, P < 0.005). Conclusions: With decreasing differentiation and increasing diameter of nodules, the use of imaging modalities to diagnose HCC improved. Tumour biopsy was required to diagnose 55% of the cases in group A and 32% of the cases in group B. © 1999 Blackwell Science Asia Pty Ltd. [ABSTRACT FROM AUTHOR]

Several basic results on nonlinear circuit problems are presented from the topological viewpoint. There have been numerous papers which studied the relations between the boundedness of the solutions and the characteristics of the nonlinear resistors. An interesting question related to this was raised by Smale and Matsumoto. Smale assumed that there exists a compact set of attraction if the power of the resistors satisfy the eventual passivities. In addition, Matsumoto conjectured that the total number of singular points is odd if eventually the circuit is passive. This paper shows that the two forementioned conjectures are true under some additional conditions concerning the singular points of the circuits. For the proof of those conjectures, we used the Morse-Smale inequalities and the technique of the Gnomon projection (Poincaré compactification) which projects the n-dimensional Euclidean space onto the n-dimensional compact sphere Sn. [ABSTRACT FROM AUTHOR]

This paper considers the generation of almost-periodic oscillation and chaos which occur in a parametric excitation circuit having an external force, and the region in which they occur. In a resonance circuit, if one of the reactances is excited with a frequency which is almost twice the resonance, a subharmonic parametric oscillation of one-half order, i.e., the parametric oscillation for short, is sustained. If an external force with frequency near the resonance is applied to the circuit, the parametric oscillation disappears. The characteristics of this oscillation disappearance are analyzed by using the nonlinearized Mathieu equation with a forcing term which describes this system. For this we assume a solution containing only two harmonic components and apply the method of harmonic balance. In this paper, using a more detailed investigation of the characteristics of the oscillation disappearance, it is clarified that chaotic phenomena occur in a part of the response curves. Advancing the forementioned method, we obtain a set of four autonomous differential equations. Plotting the solution curve of these equations in the phase plane, we may investigate the behavior of this system. Consequently, it is clarified that under proper condition of circuit parameters, the solution curve tends to a limit cycle or chaos, by only several percent variation of the frequency of the external force. A limit cycle is correlated with an almost-periodic oscillation. Therefore, the behavior of this system is revealed in more detail. [ABSTRACT FROM AUTHOR]

An 80-year-old woman consulted our hospital complaining of general weakness. She had iron deficiency anemia, and upper gastrointestinal endoscopy revealed a small lesion accompanying a small amount of fresh bleeding in the stomach. Close observation of the lesion revealed that it was composed of a local assembly of dilated microvessels. The diagnosis of this patient was gastric vascular ectasia causing anemia. Endoscopic ultrasonography demonstrated that the lesion involved the mucosal and submucosal layers of the stomach, and that there were no large vessels inflowing to or outflowing from the lesion. In the present case, we attempted endoscopic mucosal resection (EMR). The lesion was completely resected by only one procedure of EMR without complications such as bleeding. After the endoscopic treatment, iron deficiency anemia improved. Follow-up endoscopy performed 1 year later revealed that there was no residual or recurrent lesion. Although there have not been any published reports describing the use of EMR for gastric vascular ectasia, EMR may be a useful endoscopic treatment for this condition. [ABSTRACT FROM AUTHOR]

SUMMARY 1. In the present study, we investigated the potential of the proteasome inhibitor N-benzyloxycarbonyl-Ile-Glu(O-t-Bu)-Ala-leucinal (PSI) to prevent vascular hypertrophy induced by deoxycorticosterone acetate (DOCA) and salt in rats. 2. Vehicle (35% ethanol, 35% polyethylene glycol and 30% saline solution)-treated DOCA-salt rats developed marked hypertension at 4 weeks. Morphological studies on the rats given vehicle showed aortic hypertrophy, with a significant increase in wall thickness, wall area and wall-to-lumen ratio. A significant decrease in vascular wall hypertrophy was observed in PSI (3 mg/kg)-treated DOCA-salt rats. In addition, a marked increase in aortic endothelin (ET)-1 content was evident in vehicle-treated DOCA-salt rats compared with findings in sham-operated rats. A significant attenuation of this increase occurred in PSI-treated DOCA-salt rats. 3. These results indicate that PSI can prevent the vascular hypertrophy in DOCA-salt hypertensive rats and the effect is accompanied by suppression of ET-1 production in the aorta. We suggest that a proteasome-dependent proteolytic system has an important role in the development of vascular hypertrophy in cases of DOCA-salt-induced hypertension, possibly through the enhancement of ET-1 production in vascular tissues. [ABSTRACT FROM AUTHOR]

Background: Gastric atrophy induced by Helicobacter pylori is thought to predispose patients to noncardiac gastric cancer development. However, the host genetic factors that influence the progression of gastric atrophy have not been elucidated. In this study, we examined the effects of cytokine polymorphisms on H. pylori-induced gastric atrophy., Methods: Blood samples were taken from 454 Japanese subjects. The interleukin-2 (IL-2; T-330G), IL-4 (C-33T), and IL-13 (C-1111T) polymorphisms were genotyped by polymerase chain reaction with confronting two-pair primers (PCR-CTPP). Anti-H. pylori IgG antibody and pepsinogen I and II were measured to diagnose H. pylori infection and atrophic gastritis., Results: The odds ratios (ORs) for the association between IL-2 polymorphism [OR = 2.78, 95% CI (confidence interval) = 1.26-6.17 (T/T to G/G)] or IL-4 polymorphism [OR = 2.22, 95% CI = 1.01-4.89 (T/C to C/C)] were increased significantly with gastric atrophy, whereas the corresponding OR of IL-13 polymorphism was decreased with gastric atrophy [OR = 0.61, 95% CI = 0.39-0.96 (C/T and T/T to C/C)]. There were no significant H. pylori seropositivity-related differences between these polymorphisms. We examined the relationship between these polymorphisms and gastric atrophy separately in H. pylori-seropositive and -seronegative groups. In the H. pylori-seropositive group, the IL-2 T/T (OR = 2.78, 95% CI = 1.12-6.93) had a significant association with gastric atrophy., Conclusions: These results reveal that the IL-2 gene polymorphism is associated with an increased risk of gastric atrophy induced by H. pylori infection and might predispose to gastric cancer.

Background: There have been few reports concerning the occurrence of hepatocellular carcinoma (HCC) in heavy drinkers not sensitized by hepatitis B virus (HBV) or hepatitis C virus. With current advances in diagnostic methods, hypervascular tumors are often discovered on imaging findings in alcoholics, and it is important to differentiate them from HCCs., Methods: The subjects were 16 alcoholics who had hepatic nodules and were hepatitis B surface antigen negative and hepatitis C virus antibody negative and were classified into two groups: (1) the HBV group with hepatitis B surface antibody and/or hepatitis B core antibody and (2) the alcoholic group without these antibodies. Computed tomography (CT), magnetic resonance imaging, and tumor biopsy were conducted for all subjects, and digital subtraction angiography or CT during arterial portography and CT during arteriography were performed for all but one case., Results: In the alcoholic group, there were no significant differences in the clinical features between the presence and absence of HCC. All nodules in the HBV group were HCCs, whereas in the alcoholic group, 6 of 16 lesions were HCCs and the others were hyperplastic nodules. Limited to the hypervascular tumors in the alcoholic group, on magnetic resonance imaging T1-weighted images, hyperplastic nodules showed hyperintensity, whereas HCCs were iso- or hypointense., Conclusion: HCCs can occur at a high rate in alcoholics, especially in those with HBV-associated antibodies. The patients with alcoholic liver cirrhosis sometimes have hypervascular tumors that are not cancer but hyperplastic nodules, and care must be taken in their treatment.