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are (-)-epigallocatechin-3-gallate (EGCG), (-)-epicatechin (EC), (-)-epigallocatechin (EGC), and (-)-epicatechin-3gallate (ECG). EGCG is the most abundant catechin in green tea. Accumulating evidence has shown that EGCG may possess anti-oxidative and anti-inflammatory properties that may affect the pathogenesis of chronic diseases including atherosclerosis and prostatic cancer. IBD, including Crohn’s disease and ulcerative colitis, are chronically relapsing disorders of the intestine. Their pathogenic mechanism has been proposed to be a dysregulatory immune response to luminal or epithelial antigens, such as gut microflora, and is characterized by the overproduction of pro-inflammatory mediators including cytokines, chemokines, enzymes, and adhesion molecules in the inflamed intestinal mucosa. Adhesion molecules mediate the binding and movement of leukocytes to tissue components and play a critical role in facilitating the immune response at the inflammation site. Epigallocatechin-3-gallate Inhibits the Expression of Adhesion Molecules by Blocking Nuclear Factor Kappa B Signaling in Intestinal Epithelial Cells

Helicobacter pylori (H. pylori) is a major etiological factor in the development of gastric cancer. Large-scale epidemiological studies have confirmed the strong association between H. pylori infection and both cancer development and progression. Interleukin-8 (IL-8) is overexpressed in gastric mucosa exposed to H. pylori. The expression of IL-8 directly correlates with a poor prognosis in gastric cancer. IL-8 is multifunctional. In addition to its potent chemotactic activity, it can induce proliferation and migration of cancer cells. In this review, we focus on recent insights into the mechanisms of IL-8 signaling associated with gastric cancer. The relationship between IL-8 and H. pylori is discussed. We also summarize the current therapeutics against IL-8 in gastric cancer.

을 시행할 수 있는 대장내시경 검사는 적절한 진단과 치료계획의 수 립에 있어 매우 중요하다. 이번 연구에서도 다른 질환으로 진단하거나 감별이 필요하다고 판단된 22명의 환자 중 18명(81.8%)에서 조직 생 검을 통해 허혈성 결장염으로 확진할 수 있었다. 허혈성 결장염은 주로 비만곡부와 구불결장 부위에 잘 발생하는 데, 우측 결장을 침범한 경우는 예후가 더 좋지 않다. 이는 우측 결 장의 허혈이 상장간막 동맥의 혈류 저하로 인해 소장에 광범위한 허 혈성 손상이 동반되기 때문으로 알려져 있다. 이번 연구에서도 병 변은 비장굴곡 원위부를 침범한 경우가 가장 많았으나, 상행결장 을 침범한 경우와 상행결장을 포함한 전 대장을 침범한 경우가 21명 (23.6%)이나 있었다. 또한 통계학적 유의성은 없었으나 상행결장을 침범한 경우가 재원기간이 길고, 중환자실 치료비율이 높았다고 보고 하였다. 따라서 대장내시경 검사에서 호발 부위가 아닌 우측 결장에 서 병변이 관찰되더라도 허혈성 결장염의 가능성을 고려해야 할 것이 다. 대장내시경을 통한 조직 생검에서 점막의 응고괴사 및 출혈, 선구 조의 위축, 혈전의 존재 등은 허혈성 결장염에서 보다 잘 관찰되는 소 견들이다. 이러한 소견들은 증상 발생 후, 조기에 조직 생검이 이루어 졌을 때 더 잘 관찰된다고 한다. 이번 연구에서도 증상 발현부터 대 장내시경 및 조직 생검까지의 평균기간이 2.2일이었고, 병리검사에서 점막의 응고괴사 및 출혈, 선구조의 위축, 혈전의 존재 중 한 가지 이 상 관찰된 경우가 전체 환자 중 75.3%였다. 따라서 허혈성 결장염이 의심되는 경우, 대장내시경 및 조직 생검은 가급적 조기에 이루어지 는 것이 정확한 조기 진단을 위해 필요할 것으로 생각된다. 그러나 급성기의 대장염에서는 환자의 전신 상태가 저하되어 있고, 대장 천공 위험성이 증가하며, 장정결에서부터 검사의 시행까지 내시 경 수검자의 순응도가 감소하므로 대장내시경의 시행이 결코 쉬운 일 은 아닐 것이다. 스페인에서 364명을 대상으로 수행된 허혈성 결장염 에 대한 전향 관찰 연구(CIE study, Working Group for the Study of Ischemic Colitis in Spain)에서, 전체 연구 대상자의 94.8% (345명) 를 대상으로 대장내시경을 시행했지만 58.9% (202명)에서만 맹장 The Clinical Impact of Early Colonoscopic Biopsy in Ischemic Colitis

The aim of the present study was to compare the gastric juice ammonia test to the CLO test for the diagnosis of H. pylori infection in culture-proven cases by receiver operating characteristic (ROC) curve analysis. We studied 75 subjects (44 with chronic gastritis, 10 with gastric ulcer, 6 with duodenal ulcer, 8 with gastric cancer, and 7 normal) by endoscopy with biopsy for tissue diagnosis, culture of H. pylori. CLO test, and by gastric juice ammonia determinations. The culture-positive group had significantly higher intragastric ammonia levels (13.7 +/- 5.8 mg/dl) than the negative group (4.9 +/- 2.4 mg/dl, P0.01). In ROC curve analysis, the gastric juice ammonia test showed higher true positive and lower false positive ratios than the CLO test (P0.05). In conclusion, the measurement of intragastric juice ammonia levels was considered to be simpler, quicker, and overall a more valuable method for diagnosing H. pylori infection.

The human intestinal microbiota is a community of 10(13)-10(14) microorganisms that harbor in the intestine and normally participate in a symbiotic relationship with human. Technical and conceptual advances have enabled rapid progress in characterizing the taxonomic composition, metabolic capacity and immunomodulatory activity of the human intestinal microbiota. Their collective genome, defined as microbiome, is estimated to contain ≥150 times as many genes as 2.85 billion base pair human genome. The intestinal microbiota and its microbiome form a diverse and complex ecological community that profoundly impact intestinal homeostasis and disease states. It is becoming increasingly evident that the large and complex bacterial population of the large intestine plays an important role in colorectal carcinogenesis. Numerous studies show that gut immunity and inflammation have impact on the development of colorectal cancer. Additionally, bacteria have been linked to colorectal cancer by the production of toxic and genotoxic bacterial metabolite. In this review, we discuss the multifactorial role of intestinal microbiota in colorectal cancer and role for probiotics in the prevention of colorectal cancer.

6524 Background: Although busulfan-cyclophosphamide (BuCy) has been commonly used as a myeloablative conditioning (MC) regimen for allogeneic hematopoietic cell transplantation (HCT), a new MC regi...

BACKGROUND/AIMS Dominant genotype of hepatitis A virus (HAV) in Korea had been known to be genotype 1A in 1990s. Recently, the epidemiologic change of HAV genotype was reported with an upsurge of acute hepatitis A in Korea. The aim of this study was to investigate the change of HAV genotypes and clinical characteristics in Gwangju and Jeonnam province. METHODS From November 2008 to October 2009, a total of 82 patients with acute hepatitis A were enrolled prospectively. HAV genotype was determined using reverse transcriptase polymerase chain reaction and sequencing of the PCR products of VP1/2A region of HAV. RESULTS HAV RNA was detected in 82% (67/82). The genotype IIIA (88%, 59 cases) was significantly more frequent than genotype IA (12%, 8 cases) (p ≤ 0.01). The subtypes of genotype IIIA were AJ299467 Norway (49%), HA-JNG04-09 Japan (27%), HS-14-12-00 Spain (22%) and H-122 Sweden (2%). The subtypes of IA were FH1 Japan (50%) and HA J04-3 Japan (50%). The substitutions of amino acid were more frequent in genotype IIIA than IA (p≤ 0.01). There was no difference in the clinical characteristics between the patients with genotype IIIA and IA. CONCLUSIONS Genotype IIIA was a dominant genotype of recent HAV infection in Gwangju and Jeonnam province. This study provides valuable epidemiologic information of genetic distributions of HAV in Korea.

Background/Aims Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes. Methods We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality. Results Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p

6589 Background: Although daunorubicin (D) has been used as major part of induction treatment for adult acute lymphoblastic leukemia (ALL), its specific role is difficult to understand. The reason ...

6612 Background: Clinical trials, which were mostly performed in the Western countries, have demonstrated the effectiveness of decitabine in the treatment of myelodysplastic syndrome (MDS). This st...

6563 Background: Several studies showed that a higher CR rate and longer CR duration could be achieved when imatinib was added to the combination chemotherapy for Ph+ALL. Optimum use of imatinib in...

Background and aims: The patient with hepatocellular carcinoma (HCC) diagnosed for the first time was gradually older year by year in spite of the etiology in Japan. Recently the HCC naive patients diagnosed at the age over 80 years old were not rarely found. In that case, the indication of the treatment of patient with HCC was supposed to be difficult due to the liver function and their complication. The aim of this study was to assess the liver function and the prognosis of its treatment of the naive patient with HCC over 80years old. Methods: During 8years(2001~2008), 538patients (203woman and 335man) had been diagnosed for the first time as HCC by ultrasonograpy, computed tomography and magnetic resonance imaging and admitted to our hospital for the treatment. These patients were examined blood test and were performed thepatic resection, percutanous radiofrequency ablation (RFA), transcatheter chemoemblization (TACE) or conservative treatment. We classified the patients in two groups, group A: =80 years old, according to the age diagnosed for the first time, and assessed the clinical data between two groups. Results: Forty subjects (22woman and 18man, HBV:HCV:NBNC=3:28:9) out of 538HCC naive patients (7.4%, HBV:HCV:NBNC=82:383:73) were over 80years old. Women and NBNC cases were more found in the group B (p

Although triple combination therapy containing a proton pump inhibitor (PPI) and two antibiotics is considered as a standard regimen for the first-line anti-Helicobacter pylori treatment, the recent trend of eradication rates following this therapy has been declined in the last few years. The purpose of this study was to investigate the trend of H. pylori eradication rates over the last 9 years and to evaluate are clinical factors affecting eradication rates.From January 2001 to June 2009, H. pylori eradication rates in 709 patients with documented H. pylori infection who received triple combination therapy for 7 days were retrospectively evaluated according to years and various clinical factors. H. pylori status was evaluated by 13C urea breath test 4-6 weeks after completion of treatment. results: The overall H. pylori eradication rate was 77.0%. The annual eradication rates from year 2001 to 2009 were 78.9%, 72.5%, 81.0%, 75.0%, 79.1%, 77.1%, 77.8%, 77.8%, and 75.0% by per-protocol analysis. There was no decreasing tendency of the eradiation rate over 9 years (p=0.974). There was no statistical difference in the eradication rates according to age, sex, smoking, alcohol, NSAIDs, underlying diseases, endoscopic diagnosis, and PPI. However, the eradication rate was lower in patients who took aspirin (OR=0.509, 95% CI=0.292-0.887, p=0.001) and antibiotics within 6 months (OR=0.347, 95% CI=0.183-0.658, p=0.001).The H. pylori eradication rate has not changed at Gwangju-Chonnam province in Korea for recent 9 years. Lower eradication rate in aspirin and antibiotics users warrants further attention.

Background : Survivin, a novel antiapoptotic gene has been linked with tumor development and progression in various human carcinomas including gastric carcinomas. The aim of this study was to evaluate the expression of survivin in gastric carcinoma and its correlation with tumor cell proliferation and apoptosis. Methods : Expression of survivin was evaluated immunohistochemically in 84 surgically resected gastric carcinomas. Tumor cell apoptosis was evaluated with terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and Ki-67 immunostaining was used for evaluation of tumor cell proliferation. Results : Expression of survivin was noted in 53.6% of the gastric carcinomas, and was significantly associated with depth of invasion, status of lymph node metastasis or tumor stage (p=0.022, 0.034, 0.040, respectively). There was an inverse correlation between survivin expression and apoptotic index (p=0.015). But there was no significant correlation between survivin expression and Ki-67 labeling index (p=0.430). Conclusions : These results suggest that survivin expression may contribute to tumor development and progression by inhibiting apoptosis in human gastric carcinoma.

AIM: To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS: Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS: Of 3080 patients with gastrointestinal diseases, 396 (12.9%) had clonorchiasis and 1140 patients (37.2%) had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 (20.9%) patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than non-infected patients [34/396 (8.6%) vs 145/2684 (5.4%), P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation (P = 0.008). Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis. CONCLUSION: Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

Introduction: The Gram-negative bacterium Campylobacter jejuni (C. jejuni) is the leading cause of food-borne diarrheal illnesses worldwide. Limited information is available on the molecular mechanisms associated with its pathogenesis. Aim: To characterize the host responses associated with C. jejuni-induced intestinal inflammation and to define themolecular mechanisms associated with the pathogenesis. Methods: Germ-free IL-10wt/wt;NF-κBEGFP and IL-10-/-;NF-κBEGFP mice were mono-associated with different amount of C. jejuni (strain 81-176; 102, 104, 106, 109cfu/mouse). IL-10-/and IL-10-/-;Myd88-/were associated with C. jejuni under specific pathogen-free (SPF) conditions (108cfu/mouse). Bacterial colonization and extraintestinal manifestations were confirmed by culturing stool, mesenteric lymph nodes (MLN), spleen and liver collected from each group and by real-time PCR (RT-PCR). Macroscopic and confocal microscopic EGFP imaging, RT-PCR analysis and histological analysis were utilized to characterize the bacteria-induced host responses. Colonoscopy was performed to document inflammation using a mini STORZ endoscope. Results: C. jejuni mono-associated IL-10-/mice developed mild (102), moderate (104) and severe (109) inflammation by day 14 as assayed by colonoscopy. Five days after association all mice had clinical signs of inflammation as evidenced by bloody diarrhea. Macroscopic analysis showed elevated EGFP expression throughout the colon of C. jejuni (109) associated IL-10-/-;NF-κBEGFP mice. All mice were colonized equally with C. jejuni as confirmed by RT-PCR and stool sample cultures. Histological analysis showed severe crypt hyperplasia, goblet cell depletion, ulcers and immune cell infiltration. TNF and IL-12p40 mRNA were significantly induced in the colon of these mice compared to WT mice. C. jejuni-induced IL-12p40, IL-23p19 and TNF gene expression was reduced in BMCD generated from IL-10-/-;Myd88-/compared to IL10-/mice. Interestingly, the onset and extent of C. jejuni-induced colitis is similar between IL-10-/-;Myd88-/and IL-10-/mice with comparable induction of TNF, Nod2, and IL-23p19 gene expression. Conclusion: Our findings indicate that C. jejuni induces rapid and severe intestinal inflammation in a susceptible host, which correlates with enhanced NF-κB activity. C. jejuni-induced colitis in IL-10-/mice appears to be mediated by a Myd88-independent pathway. These findings raise the possibility that Nod proteins are involved in C. jejuniinduced colitis.

8069 Background: The present study was conducted to evaluate the safety and efficacy of alemtuzumab plus CHOP chemotherapy for patients with peripheral T-cell lymphomas (PTCLs). Methods: Twenty patients with newly diagnosed PTCLs were enrolled. The treatment consisted of classical CHOP plus alemtuzumab (10 mg/m2 i.v on day 1 and 20 mg/m2 i.v on day 2 in the first cycle, then 30 mg/m2 i.v on day 1 in the subsequent cycles) based on 3-week intervals. Results: Thirteen complete responses (65.0%) and 3 partial responses (15.0%) were confirmed, giving an overall response rate of 80.0 %. The estimated event-free survival at 1 year was 43.3%. The most severe hematologic adverse event was neutropenia, which occurred with a grade 4 intensity in 18 patients (90.0%). Plus, febrile neutropenia was observed in 11 patients (55.0%). Five patients (25%) experienced CMV (cytomegalovirus) reactivation, while 3 patients developed CMV diseases, such as pneumonitis or retinitis. There were 2 treatment-related deaths. Conclusions: The alemtuzumab plus CHOP chemotherapy seemed to produce active antitumor activity in terms of the complete response rates in patients with PTCLs. However, since high infectious and hematologic toxicities were observed, careful monitoring and early treatment to prevent treatment-related mortality are needed. No significant financial relationships to disclose.

Background : The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 β-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. M ethods : Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. Results : The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4±15.7. The mean KI value of the c-FLIP positive tumors was 54.1±15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4± 2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). Conclusions : These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.

Partial or complete agenesis of the dorsal pancreas is a rare congenital anomaly that results from the embryological failure of the dorsal pancreatic bud to form the body and tail of the pancreas. To date, four cases have been reported in Korea. We report an additional case; a 25-year-old woman presented with diabetes mellitus and abdominal pain. Abdominal computed tomography (CT) revealed a normal-appearing pancreatic head, but the body and tail were not visualized. Endoscopic cholangiopancreatogram (ERCP) revealed a short pancreatic duct in the uncinate process and the head and the duct of Santorini draining into the minor papilla. Abdominal magnetic resonance imaging (MRI) findings were similar to the CT and ERCP results. The patient was diagnosed with partial agenesis of the dorsal pancreas by CT, ERCP and MRI.

It has been reported that p53 mutation may contribute to upregulate cyclooxygenase (COX)-2 expression that is observed in malignant tissues. These molecules are involved in carcinogenesis by affecting tumor cell proliferation. The aim of this study was to examine the relationship between COX-2 or p53 expression and clinico-pathological characteristics including tumor cell proliferation in gastric cancer. COX-2 and p53 expressions were investigated with immunostaining, in tissue specimens obtained from 119 patients who underwent surgery for gastric cancer. The Ki-67 labeling index (LI) was counted by Ki-67 immunostaining. COX-2 and p53 expressions correlated significantly with depth of tumor invasion. However, there was no association between COX-2 or p53 expression and survival. p53 expression did not correlate with COX-2 expression. There was no significant difference in various clinicopathological variables between Ki-67 LI subgroups. The mean Ki-67 LI value of COX-2 positive tumors was significantly higher than that of negative tumors. The mean Ki-67 LI value of p53 positive tumors was not significantly higher than that of negative tumors. The mean Ki-67 LI value of both COX-2 and p53 positive tumors was significantly higher than that of both negative tumors. These results imply that COX-2 expression is associated with tumor cell proliferation of gastric cancer.

Successful Endoscopic Management of Bleeding From Colonic Dieulafoy Lesion: A Case Review of Six Years’ Experience Wan Sik Lee, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew, Sei Jong Kim Background: Dieulafoy lesion is a relatively uncommon disease which is a potential source of life threatening gastrointestinal hemorrhage. The lesions outside of the stomach are rare occurrences. Colorectal Dieulafoy lesions typically present with painless, massive hemorrhage, and difficult to be located during endoscopy. Materials: Over 6 years (July 1999 to October 2004), eleven colorectal Dieulafoy lesions were identified at our tertiary referral center, and received endoscopic treatment. Mean age was sixty-nine years. Results: Seven cases were located at sigmoid colon and four cases at the distal rectum. Four patients were in end stage renal disease and three patients were at the condition of multiple organ failure due to various causes. In all of the patients, endoscopic treatment was successful. Six patients received epinephrine-saline injection followed by hemoclipping and remaining patients were treated by rubber band ligation. None of the patients experienced recurrent bleeding. Three patient died, but none as a result of hemorrhage. Conclusion: The fact that colorectal Dieulafoy lesion is one of the cause of massive hemorrhage should be reminded when initial diagnostic workup failed to elucidate the bleeding source, especially in elderly patients with end stage renal disease and multi-organ failure. Endoscopic mechanical hemostatic method is effective for permanent treatment of colorectal Dieulafoy leions.

23%; p Z 0.0045), overgrowth (5%, 0%; p Z 0.09), migration (17.5%, 0%; pZ0.0011), and the rate of additional intervention (25%, 23%; p Z 0.83). But there was no significant difference in DS- ingrowth (6.6%, 9.5%; p Z 0.75), overgrowth (0%, 0%), migration (13.3%, 0%; p Z 0.085), the rate of additional intervention (20%, 9%; p Z 0.37). Overall stent patency duration was similar

Osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, of which the histiogenesis remains controversial. A 63-yr-old woman was hospitalized for evaluation of epigastric pain. An abdominal computerized tomography revealed the presence of a large cystic mass, arising from the tail of pancreas. A distal pancreatectomy with splenectomy was performed. Histologically, the tumor was composed of mononuclear stromal cells intermingled with osteclast-like giant cells. In addition, there was a small area of moderately to well differentiated ductal adenocarcinoma. The final pathologic diagnosis was osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma. Here, we describe the histopathological, immunohistochemical, ultrastructural and molecular biological findings of this tumor with review of the literature pertaining to this condition.

We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudo-obstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple air-fluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gut-derived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudo-obstruction.

Mast cells (MC) may be one factor influencing the response of visceral afferent nerves to mechanical and chemical stimuli. The aim of this study was to evaluate the degree of infiltration and activity of colonic MC in irritable bowel syndrome (IBS). Biopsy specimens were obtained from the cecum and rectum of 14 diarrhea predominant IBS and 14 normal controls. Electron microscopy was used to determine the number of intact and degranulated colonic MC and to quantify these separately according to the distance between MC and enteric nerves. An increased number of MC in both cecum and rectum in the IBS group in comparison with the control group was demonstrated (p