Vascular endothelial growth factor expression and angiogenesis in gastric carcinoma / 대한내과학회지

BACKGROUND: Many studies have shown that angiogenesis plays an important role in the growth and progression of solid tumors, including gastric carcinoma. Vascular endothelial growth factor(VEGF) is the most potent known inducer of microvascular hyperpermeability; in addition, it is a selective mitogen for endothelial cells. In this study, we studied that the relationship between angiogenesis and the expression of VEGF in gastric carcinoma. METHODS: 23 early gastric carcinomas and 28 advanced gastric carcinomas obtained by surgical resection were studied. Expression of the VEGF was semiquantitatively analyzed in paraffin sections by immunohistochemical method. Histologic sections immunostained for CD31 antigen were evaluated for microvessel density. RESULTS: The VEGF was mainly localized to the cytoplasm of carcinoma cells. Expression of the VEGF was significantly higher in advanced gastric carcinoma than in early gastric carcinoma (p 0.05). The expression of CD31 was higher in advanced gastric carcinoma than in early gastric carcinoma. In gastric carcinoma, a correlation was observed between CD31 expression and the stage of the disease, the degree of histological differentiation. Also VEGF and CD 31 expression was observed significant correlation. CONCLUSION: VEGF is an important angiogenic factor associated with progression of the gastric carcinoma. Neovascularization assessment by CD 31 immunostaining was another efficient method for defining groups of tumors with aggressive clinical course.

The endoscopic diagnosis and treatment for Mallory-Weiss syndrome / 대한내과학회지

BACKGROUND: Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. METHODS: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. RESULT: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. CONCLUSION: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.

A Case of Gastric Kaposi's Sarcoma Successfully Treated with VP-16 / 대한소화기내시경학회지

Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. However, extracutaneous lesions are common and the gastrointestinal tract is often involved. Gastric Kaposi's sarcoma is usually asymptomatic, but may cause massive gastrointestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodules. In Korea, only one case of gastric Kaposi's sarcoma had been reported until now. A case of gastric Kaposi's sarcoma treated with VP-16 (etoposide) is here in reported with the endoscopic findings before and after chemotherapy.

Clinical significance of lens culinaris agglutinin-A reactive AFP for differential diagnosis of hepatocellular carcinoma and liver cirrhosis / 대한내과학회지

AFP has been the most useful tumor marker of hepatocellular carcinoma (HCC) because AFP is tumor specific and organ specific. However it can be elevated in liver cirrhosis (LC) and chronic hepatitis as well. AFP in hepatocellular carcinoma has been known to be highly reactive Lens Culinaris Agglutinin-A (LCA-A). The aim of our study is to find whether LCA-A reactive AFP (AFP-L3) is useful in differentiation of HCC and LC with high serum AFP level (>20 ng/ml). METHODS: The material consists of sera from 18 patients with HCC and 16 patients with LC whose serum AFP concentration was above 20 ng/ml. Sera were tested for AFP-L3 by lectin-affinity electrophoresis, coupled with antibody affinity blotting with alpha-fetoprotein differentiation kit L (Wako Pure Chemical Industries, Osaka, Japan). AFP-L3 fraction percentage was checked by densitometry (580nm, Cliniscan II, Helena). RESULTS: AFP-L3 detection rate in membrane was 61.1% in HCC and 37.5% in LC. When cut-off value level is 15%, the positive rate was 61.1% in HCC and 31.2% in LC, and sensitivity and specificity of AFP-L3 fraction in HCC was 61.1% and 68.8% respectively. In according to these results, AFP-L3 was a useful marker in differentiation HCC and LC with high serum AFP level. There was no significant relation in AFP-L3 fraction and tumor size, but there was significant relation between AFP-L3 fraction and total AFP serum level(P=0.049). CONCLUSION: These results lead us to conclude that the level of AFP-L3 is a useful marker in differentiation of HCC and LC with high serum AFP level.

Clinical significance of lens culinaris agglutinin-A reactive AFP for differential diagnosis of hepatocellular carcinoma and liver cirrhosis / 대한내과학회지

AFP has been the most useful tumor marker of hepatocellular carcinoma (HCC) because AFP is tumor specific and organ specific. However it can be elevated in liver cirrhosis (LC) and chronic hepatitis as well. AFP in hepatocellular carcinoma has been known to be highly reactive Lens Culinaris Agglutinin-A (LCA-A). The aim of our study is to find whether LCA-A reactive AFP (AFP-L3) is useful in differentiation of HCC and LC with high serum AFP level (>20 ng/ml). METHODS: The material consists of sera from 18 patients with HCC and 16 patients with LC whose serum AFP concentration was above 20 ng/ml. Sera were tested for AFP-L3 by lectin-affinity electrophoresis, coupled with antibody affinity blotting with alpha-fetoprotein differentiation kit L (Wako Pure Chemical Industries, Osaka, Japan). AFP-L3 fraction percentage was checked by densitometry (580nm, Cliniscan II, Helena). RESULTS: AFP-L3 detection rate in membrane was 61.1% in HCC and 37.5% in LC. When cut-off value level is 15%, the positive rate was 61.1% in HCC and 31.2% in LC, and sensitivity and specificity of AFP-L3 fraction in HCC was 61.1% and 68.8% respectively. In according to these results, AFP-L3 was a useful marker in differentiation HCC and LC with high serum AFP level. There was no significant relation in AFP-L3 fraction and tumor size, but there was significant relation between AFP-L3 fraction and total AFP serum level(P=0.049). CONCLUSION: These results lead us to conclude that the level of AFP-L3 is a useful marker in differentiation of HCC and LC with high serum AFP level.