Biomimetic Metal-Organic Framework Composite-Mediated Cascade Catalysis for Synergistic Bacteria Killing.

Encapsulating nanoparticles/biomolecules into metal-organic freamworks (MOFs) has proven to be highly effective in creating new functions during their applications. However, it is highly desirable yet remains challenging to achieve the synergy of specific functions between the MOF host and guest species. Herein, inspired by the natural multienzyme system, a novel MOF composite biomimetic structure based on the coencapsulation of glucose oxidase (GOx) and l-arginine (l-Arg) into Cu-MOFs (CuBDC) with Fenton-like catalytic activity is designed for achieving the synergistic antibacterial effect. Once activated by GOx-catalyzed glucose oxidation, a large amount of oxygen radicals, toxic ONOO-, and NO are rapidly produced over this well-designed l-Arg/GOx@CuBDC through a double-cascade reaction. Thanks to the synergy of highly reactive species, outstanding antibacterial effects (bacterial inactivation ≥97%) are observed at very low doses (38 µg mL-1 for Escherichia coli and 3.8 µg mL-1 for Staphylococcus aureus). In addition, the in vivo experiment in mice demonstrated that the as-prepared l-Arg/GOx@CuBDC has good biocompatibility, indicating its good potential in practical applications. Such a biomimetic multienzyme system proposes a new design idea for highly efficient antibiosis as well as even therapy for tumors.

Toxic effects of arsenic trioxide on spermatogonia are associated with oxidative stress, mitochondrial dysfunction, autophagy and metabolomic alterations.

Arsenic is a toxic metalloid that can cause male reproductive malfunctions and is widely distributed in the environment. The aim of this study was to investigate the cytotoxicity of arsenic trioxide (ATO) induced GC-1 spermatogonial (spg) cells. Our results found that ATO increased the levels of catalase (CAT) and malonaldehyde (MDA) and reactive oxygen species (ROS), while decreasing glutathione (GSH) and the total antioxidant capacity (T-AOC). Therefore, ATO triggered oxidative stress in GC-1 spg cells. In addition, ATO also caused severe mitochondrial dysfunction that included an increase in residual oxygen consumption (ROX), and decreased the routine respiration, maximal and ATP-linked respiration (ATP-L-R), as well as spare respiratory capacity (SRC), and respiratory control rate (RCR); ATO also damaged the mitochondrial structure, including mitochondrial cristae disordered and dissolved, mitochondrial vacuolar degeneration. Moreover, degradation of p62, LC3 conversion, increasing the number of acidic vesicle organelles (AVOs) and autophagosomes and autolysosomes are demonstrated that the cytotoxicity of ATO may be associated with autophagy. Meanwhile, the metabolomics analysis results showed that 20 metabolites (10 increased and 10 decreased) were significantly altered with the ATO exposure, suggesting that maybe there are the perturbations in amino acid metabolism, lipid metabolism, glycan biosynthesis and metabolism, metabolism of cofactors and vitamins. We concluded that ATO was toxic to GC-1 spg cells via inducing oxidative stress, mitochondrial dysfunction and autophagy as well as the disruption of normal metabolism. This study will aid our understanding of the mechanisms behind ATO-induced spermatogenic toxicity.

Akt pathway is required for oestrogen-mediated attenuation of lung injury in a rodent model of cerulein-induced acute pancreatitis.

BACKGROUND: The phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) is known to be an endogenous negative feedback or compensatory mechanism that serves to limit pro-inflammatory and chemotactic events in response to injury. The aim of this study is to elucidate whether Akt plays any role in 17ß-estradiol (E2)-mediated attenuation of lung injury after acute pancreatitis (AP). MATERIALS AND METHODS: Male Sprague-Dawley rats underwent cerulein-induced AP. Rats were treated with vehicle (cyclodextrin), E2 (1 mg/kg body weight [BW]), or E2 plus PI3K/Akt inhibitor Wortmannin (100 µg/kg BW) 1h after the onset of AP. At 8 h after sham operation or AP, various parameters were measured. RESULTS: AP led to a significant decrease in lung Akt phosphorylation, which was associated with increased lung tissue myeloperoxidase (MPO) activity, wet-to-dry weight ratios, interleukin (IL)-6, tumor necrosis factor (TNF)-α, cytokine-induced neutrophil chemoattractant (CINC)-1, and CINC-3 levels. Administration of E2 after AP restored the AP-induced decrease in Akt phosphorylation and attenuated the increase in lung injury markers (MPO activity and wet-to dry weight ratios) and pro-inflammatory mediator production. The effects of E2 on the lung were abolished by co-administration of Wortmannin. CONCLUSIONS: These results collectively suggest evidences that the Akt pathway seems to be required for E2-mediated protection of lung injury after AP.

Clinicopathologic features and predictors for survival of mucinous and non-mucinous appendiceal adenocarcinoma.

BACKGROUND/AIMS: We report a study in patients with mucinous and non-mucinous appendiceal adenocarcinoma treated surgically whose records were examined to elucidate their clinicopathologic features and prognostic factors for survival. METHODS: The medical records of 34 patients with mucinous and non-mucinous appendiceal adenocarcinoma (1991-2005) were retrospectively reviewed. RESULTS: There was no significant difference between mucinous and non-mucinous tumors in patient demographics, clinicopathologic features, type of operation and outcome. Non-mucinous tumors had a higher incidence of leukocytosis than mucinous ones. The overall 5-year survival rate for 34 patients with appendiceal adenocarcinoma was 35.8%. In the univariate analysis, predictors of survival were the type of operation, resectability, carcinomatosis and tumor stage. Tumor stage significantly influenced patient survival in the multivariate analysis. CONCLUSION: Mucinous appendiceal adenocarcinoma had clinicopathologic characteristics and a prognosis similar to non-mucinous, except that there was more leukocytosis in non-mucinous tumors. Tumor stage is an independent predictor for survival among patients with appendiceal adenocarcinoma.

Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma.

BACKGROUND: Pancreatic adenosquamous carcinoma (ASC) is a rare pancreatic malignancy subtype. We investigated the clinicopathological features and outcome of pancreatic ASC patients after surgery. METHODS: The medical records of 12 patients with pancreatic ASC undergoing surgical treatment (1993 to 2006) were retrospectively reviewed. Survival data of patients with stage IIB pancreatic adenocarcinoma and ASC undergoing surgical resection were compared. RESULTS: Symptoms included abdominal pain (91.7%), body weight loss (83.3%), anorexia (41.7%) and jaundice (25.0%). Tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Median tumor size was 6.3 cm. Surgical resection was performed on 7 patients, bypass surgery on 3, and exploratory laparotomy with biopsy on 2. No surgical mortality was identified. Seven (58.3%) and 11 (91.7%) patients died within 6 and 12 months of operation, respectively. Median survival of 12 patients was 4.41 months. Seven patients receiving surgical resection had median survival of 6.51 months. Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma. CONCLUSION: Aggressive surgical management does not appear effective in treating pancreatic ASC patients. Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

A case of gastrointestinal stromal tumor with hyperinsulinemic hypoglycemia.

Gastrointestinal stromal tumor (GIST) is an uncommon malignant tumor that has recently been drawn to the attention of clinicians because of the protean clinical spectrum, endocrinological pathogenesis, aggressive metastatic features, poor prognosis, oncogenic tyrosine kinase receptor mutation and its brilliant revolutionized inhibitor imatinib. However, very few cases of GIST and hypoglycemia have been reported worldwide and they are usually associated with normal or low insulin levels. Here, we report on a rare case of GIST with postabsorptive hypoglycemia, extraordinary hyperinsulinemia and low insulinlike growth factor I (IGF-I). Its unusual neurological presentation made its diagnosis very difficult. After a complete resection, the symptoms diminished. We point out the unusual endogenous hyperinsulinism, clinical features and postulate possible mechanisms.

PIK3CA exon 20 mutation is independently associated with a poor prognosis in breast cancer patients.

BACKGROUND: Prognostic factors that could select breast cancer patients with poor survival, and influence clinical trials of targeted therapy, are needed. However, the reported observations regarding the impact of PI3KCA mutation on breast cancers are controversial. METHODS: We analyzed exons 4, 7, 9, and 20 of PI3KCA on a series of 158 patients. Clinicopathological characteristics were correlated with the mutation data. RESULTS: Among 152 patients who were available for follow-up (median follow-up time, 6.57 years), 26% had PIK3CA mutations, more than half of which occurred in exon 20. The five-year survival rate of patients with exon 20 mutations (46%) was significantly lower than that of patients without (75%) (p = 0.0054). Multivariate analysis showed that PIK3CA exon 20 mutations and nodal involvement were independent risk factors for overall survival. The relative risk of death in patients with PIK3CA exon 20 mutations was 2.881 (95% CI, 1.406-5.900; p = 0.0038). CONCLUSIONS: PIK3CA mutations are common in invasive ductal carcinomas of the breast. Our result suggests that PIK3CA exon 20 mutation is an independent risk factor for poor prognosis in breast cancer patients, indicating that differences in patient numbers with PIK3CA exon 20 mutations in study and control arms should be avoided in clinical trials of PI3K inhibitors.

Pancreaticoduodenectomy versus Frey's procedure for chronic pancreatitis: preliminary data on outcome and pancreatic function.

PURPOSE: Several surgical treatments have been proposed for treating chronic pancreatitis (CP), including standard pancreaticoduodenectomy (PD), pylorus-preserving PD, Beger's procedure, and Frey's procedure; however, few studies have compared pre- and postoperative pancreatic function in patients undergoing surgery for CP. METHODS: Between 1996 and 2003, 42 patients with CP underwent pancreatic head resection; as PD in 17 and as Frey's procedure in 25. Frey's procedure was chosen if the pancreatic duct was dilated more than 5 mm. We conducted this prospective, nonrandomized study to compare the pre- and postoperative status after PD or Frey's procedure by evaluating pancreatic function and symptom relief. RESULTS: The demographic features, surgical morbidity, and mortality were similar in the two groups. Pancreatic exocrine function improved, pain subsided, and complications of the adjacent organs resolved after surgery in both groups. Similar postoperative endocrine and exocrine functional results were observed in both groups. Frey's procedure was associated with a significantly shorter hospital stay than PD (10.6 versus 15.4 days, respectively; (P < 0.0001)). CONCLUSION: There were no significant difference in operative time, surgical morbidity, or mortality rates between PD and Frey's procedure. Both procedures were equally effective in terms of pain relief, improvement of pancreatic exocrine function, and control of complications affecting the adjacent organs; however, Frey's procedure was associated with a significantly shorter hospital stay.

Anaplastic carcinoma of the thyroid arising more often from follicular carcinoma than papillary carcinoma.

BACKGROUND: Anaplastic thyroid carcinoma (ATC), a rare and highly malignant tumor, has long been thought to arise from well-differentiated carcinoma (WDC) such as follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC). The purpose of this study was to test this notion by examining whether and, if so, how often ATC harbors the oncogenes that are commonly associated with WDC, such as RAS in FTC and BRAF in PTC. METHODS: We analyzed the mutation hotspots of BRAF (codon 600) and N-, K-, and H-RAS (codons 12, 13, and 61) in 16 ATCs. We also examined two genes, PIK3CA (exons 9 and 20) and TP53 (exons 5-9), both of which have been reported in ATCs. RESULTS: The results showed that approximately 31% (5 of 16) of ATCs harbored N-RAS mutation, 6% (1 of 16) had mutated BRAF, and approximately 56% (9 of 16) had mutated TP53. As to the three ATCs that had coexisted PTCs, mutated BRAF was detected in all PTC components but only in one ATC, while mutated PIK3CA was found in only one PTC component but not in the ATC. CONCLUSION: A number of ATCs arise from WDCs, more often from RAS-mutant tumors than from BRAF-mutant tumors, implying that particular attention should be paid to the WDC harboring RAS mutation.

Primary angiosarcoma of the spleen in a child with long-term survival.

Primary angiosarcoma of the spleen is a very rare and aggressive neoplasm with poor prognosis. Splenic angiosarcoma rarely occurs in the pediatric group (18 years or younger). Survival duration for pediatric patients is very limited. We report a 7-year-old boy with splenic angiosarcoma presented with left upper quadrant abdominal pain and a palpable abdominal mass. Hematogram revealed anemia. Abdominal ultrasound revealed a heterogeneous mass about 12 cm in diameter in the left upper abdomen. Abdominal computed tomography demonstrated a huge heterogeneous mass with some cystic components closely attached to the spleen. Splenectomy was performed. Histological examination of the surgical specimen showed that this tumor had typical feature of angiosarcoma including vasoformative architecture, highly pleomorphic tumor cells with irregular, hyperchromatic and prominent nucleoli, and some mitosis. The postoperative course was uneventful. The patient was disease free at 16 years after surgery. This is the longest reported duration of survival in a patient with splenic angiosarcoma.

Follicular dendritic cell sarcoma mimicking giant cell carcinoma of the pancreas.

Extranodal follicular dendritic cell (FDC) tumors are rare. Recognition of the morphological spectrum of FDC tumors is important to clinical diagnosis. Herein is presented a case of pancreatic FDC sarcoma with unusual clinicopathological features. A 64-year-old male patient presented with weight loss, poor appetite, abdominal fullness, mild anemia and mild peripheral eosinophilia. Histologically, the tumor was composed of both epithelioid and spindle cells with abundant intracytoplasmic hyaline globules. These tumor cells were positive for CD21, CD23, CD35, S-100 protein, fascin and clusterin. Both epithelioid and spindle tumor cells independently colonized the liver and formed two tumor nodules 18 months after the initial resection. Notably, the two hepatic metastases additionally acquired patchy expression of human leukocyte antigen-DR. The epithelioid FDC in one of the hepatic lesions transformed into numerous bizarre giant cells, which could easily be confused with a metastatic giant cell carcinoma from the pancreas. FDC tumor should therefore be included in the differential diagnoses when dealing with a giant cell tumor.

Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity: report of a case.

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive malignancy with distinctive histological features: a nesting pattern of cellular growth within dense desmoplastic stroma, occurring in young population with male predominance. The mean survival period is only about 1.5-2.5 years. The tumor has co-expressed epithelial, muscle, and neural markers in immunohistochemical studies. This work reports a 27-year-old man presenting with hematemesis and chronic constipation. Serial studies including endoscopy, upper gastrointestinal series, abdominal computed tomography and barium enema study showed disseminated involvement of visceral organs. The patient underwent aggressive surgery and received postoperative adjuvant chemotherapy consisting of 5-fluorouracil, cyclophosphamide, etoposide, doxorubicin, and cisplatin. He survived without any disease for 20 mo after the surgery. No standard treatment protocol has been established. Aggressive surgery combined with postoperative multi-agent adjuvant chemotherapy is justified not only to relieve symptoms but also to try to improve the outcome in this advanced DSRCT young patient.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis.

BACKGROUND: A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. METHODS: The medical records of 9 patients (8 males and 1 female; age range, 28-71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4-87 months). RESULTS: Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%. CONCLUSION: Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.

Melatonin reduces pancreatic prostaglandins production and protects against caerulein-induced pancreatitis in rats.

Melatonin has been used to treat experimental pancreatitis, although not all the drug's therapeutic mechanisms of melatonin have been defined. Prostaglandins (PGs) are proinflammatory mediators that exert their effects mainly locally during inflammatory diseases. The present study was undertaken to examine whether treatment with melatonin influences local PG production. An acute pancreatitis model in male Sprague-Dawley rats (225-275 g) was established by continuously infusing caerulein (15 mg/kg/hr). Mean arterial pressure and pancreatic perfusion were monitored continuously. Melatonin was delivered via the intraperitoneal route at doses of either 2 or 10 mg/kg, 30 min after caerulein injection. Malondialdehyde and glutathione levels of the pancreas and liver and the trypsinogen activation peptide levels in the serum were measured at the end of the experiment (8 hr after infusion of caerulein). Intraperitoneal injection of melatonin (2 and 10 mg/kg) reduced the reduction in systemic arterial pressure and decreased pancreatic perfusion in the rat model of caerulein pancreatitis. Moreover, melatonin treatment changed local PG production toward control level. Higher dose of melatonin was somewhat more effective in preventing the caerulein-induced alterations than was the lower dose.

Primary angiosarcoma of the spleen.

BACKGROUND AND OBJECTIVES: Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate and dismal prognosis. Since only a few cases have been adequately reported in the medical literature, we report here a further six cases. METHODS: The records of all cases of primary splenic angiosarcoma treated at Chang Gung Memorial Hospital from April 1991 to July 2004 were retrospectively reviewed. RESULTS: Of the six cases identified (three men and three women; range, 7-69 years; median, 44 years), four presented with palpable abdominal masses or left upper quadrant abdominal pain. Other systemic symptoms, such as bleeding gums, fatigue, fever, body weight loss, and gastrointestinal bleeding were noted. An abnormal hematogram was found in five patients, with all of these five showing anemia, and three thrombocytopenia. Splenomegaly was present in all patients. Hemoperitoneum due to splenic rupture was noted in one patient. Three patients had distant metastasis to the liver (n = 2), bone (n = 1), bone marrow (n = 1), and small bowel (n = 1) at diagnosis. Liver (n = 3), bone (n = 1), and bone marrow (n = 1) metastases were found in four patients after initial therapy. Five of the six cases underwent a splenectomy, one underwent partial hepatectomy, and one received chemotherapy. The respective 1-, 3- and 5-year survival rates were 60%, 40%, and 40%, and the median survival time was 36 months. One patient was disease-free 162 months after splenectomy. CONCLUSIONS: The clinical presentations of splenic angiosarcoma were similar to those of previous reports apart from the higher rate of splenomegaly observed in this study. In contrast to reported pediatric cases, our patient achieved long-term disease-free survival after splenectomy alone.

Adenosquamous carcinoma of the pancreas.

BACKGROUND/AIMS: Adenosquamous carcinoma (ASC) of the pancreas is rare and correct preoperative diagnosis is difficult. Case reports of ASC of the pancreas are sporadic and have typically employed small series. This study investigated the clinicopathological features of 7 cases of ASC of the pancreas and reviewed the pertinent literature to elucidate this rare disease. METHODOLOGY: Seven patients (4 men and 3 women; age range 38-79 years; median 66 years) with ASC of the pancreas who underwent surgical treatment at Chang Gung Memorial Hospital between February 1993 and April 2000 were retrospectively reviewed. RESULTS: Symptoms of ASC were as follows: abdominal pain (85.7%), body weight loss (85.7%), jaundice (42.9%) and anorexia (42.9%). The tumors were located at the head of the pancreas in 4 patients (57.1%), at the body in 2, and at the tail in 2. One patient had ASC at the body and tail. Most cases (5/7, 71.4%) were anemic. Seven (100%) and 5 patients (71.4%) had elevated serum CEA and CA19-9 levels, respectively. Curative pancreaticoduodenectomy was performed on 2 patients, bypass surgery on 3, and exploratory laparotomy on 2. Two patients underwent intraoperative radiotherapy. Three patients received postoperative adjuvant chemotherapy. No surgical mortality or morbidity occurred. Five of 7 patients (71.4%) died within 6 months after surgery. The median survival of the 7 patients was 4.41 months (range 1.12-22.42). CONCLUSIONS: Patients with ASC present symptoms similar to those of adenocarcinoma of the pancreas. Most patients had dismal prognosis despite aggressive surgery with or without adjuvant therapy.

Actinomycosis mimicking recurrent carcinoma after Whipple's operation.

Actinomycosis is a rare, chronic, spreading, suppurative, granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple's operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.

Outcome of pancreaticoduodenectomy for chronic pancreatitis.

BACKGROUND AND PURPOSE: Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and pancreatic endocrine/exocrine function. METHODS: This retrospective analysis included 24 consecutive patients with chronic pancreatitis who received PD from April 1995 to March 2003. There were 21 men and 3 women. The age of the patients ranged from 21 years to 73 years, with a mean age of 44 years. Alcohol abuse, found in 14 patients (58.3%), was the most common predisposing factor. Local complications included stenosis of the pancreatic duct in 15 patients, biliary obstruction in 9, duodenal obstruction in 4 and left-sided portal hypertension in 1. The surgical indications were recurrent intractable pain (n=16), local complications (n=18), and suspicion of malignancy (n=6). Endocrine pancreatic function was assessed by the need to treat diabetes mellitus with dietary modification, oral hypoglycemic agents or insulin. Pancreatic exocrine function was assessed based on clinical symptoms. Pain severity was evaluated using a scoring system based on the use of analgesic medication. The mean duration of follow-up in 22 of 24 patients was 31 months, with a range of 4 to 90 months. RESULTS: Preoperatively, pancreatic exocrine insufficiency was detected in 3 patients (3/24, 12.5%), exocrine insufficiency in 5 (5/24, 20.8%) and intractable abdominal pain requiring morphine injection in 16 (16/24, 66.7%). After PD, 4 patients had 5 complications, resulting in a morbidity rate of 17% and a mortality rate of 4%. Postoperative diabetes mellitus developed de novo in 3 patients (3/20, 15%) and postoperative pancreatic exocrine insufficiency was detected in 14 patients (14/22, 63.6%). Complete pain relief after surgery was noted in 12 patients (12/14, 85.7%). CONCLUSIONS: In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function.

Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding.

Primary splenic angiosarcoma is a very rare, aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

Efficacy of gabexate mesilate on disseminated intravascular coagulation as a complication of infection developing after abdominal surgery.

BACKGROUND AND PURPOSE: Gabexate mesilate (GM) is a promising anticoagulation treatment for disseminated intravascular coagulation (DIC). This study was designed to examine the effect of GM on DIC associated with the development of infection after abdominal surgery in the intensive care unit (ICU). METHODS: From January 1999 to March 2002, 50 consecutive ICU patients suffering DIC associated with the development of infection after abdominal surgery were enrolled in this study. Twenty five of the patients were randomized to receive treatment with GM by central intravenous infusion at 1 mg/kg/hour for 5 days or longer, while the remaining 25 were not treated. Blood clotting tests were performed and cytokine levels including tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were examined on days 1, 3, and 7 after admission. General blood tests and D-dimer tests were conducted before and after GM administration. The gender, age, mortality, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and severity of DIC were compared between the 2 groups. RESULTS: No significant difference was found between the 2 groups in TNF-alpha and IL-6 concentration on days 1, 3, and 7. The mortality rate was similar between the 2 groups. However, DIC and APACHE-II scores were significantly lower in the GM-treated patients than in controls. CONCLUSION: In this study, GM (1 mg/kg/hour) did not reduce the concentration of TNF-alpha and IL-6, or alter the mortality rate in patients with DIC resulting from infectious complications after surgery. Nevertheless, APACHE-II scores indicated that GM reduced the DIC severity and improved the clinical condition of patients.