Superior mesenteric and portal vein thrombosis caused by congenital antithrombin III deficiency: report of a case.

A 50-year-old man presented with a 24-h history of gradually worsening abdominal pain. Enhanced computed tomography showed segmental dilation of the small intestine, wall thickening, and ascites, as well as thrombosis of the superior mesenteric vein (SMV) and portal vein. Thus, an emergency laparotomy was performed, which revealed segmental intestinal infarction caused by the thrombosis in the SMV and portal vein. We resected the necrosed intestine and performed anastomosis. The patient was given intravenous heparin and nafamostat mesilate as anticoagulation therapy. The abdominal pain again recurred 4 days after this operation, necessitating a second laparotomy. Segmental congestion of the intestine was found and another resection was done, after which he recovered rapidly. Blood chemistry subsequently revealed an antithrombin III deficiency, which was confirmed to be inherent, after screening his family. Thus, laboratory testing for these proteins may help define the cause of mesenteric venous thrombosis.

Clinicopathologic significance of hypoxia-inducible factor 1alpha overexpression in gastric carcinomas.

BACKGROUND: Hypoxia-inducible factor 1alpha (HIF-1alpha) plays a key role in responses to hypoxia and expression of HIF-1alpha downstream genes leads to both an adapted metabolism and increased oxygen supply. We investigated the clinical significance of HIF-1alpha expression in gastric carcinoma. METHODS: We examined HIF-1alpha, vascular endothelial growth factor (VEGF), and insulin-like growth factor-2 (IGF-2) expression patterns immunohistochemically in 126 specimens of gastric carcinoma. CD34 antigen levels were also examined by immunohistochemistry to determine microvessel density (MVD) within tumors and correlations between HIF-1alpha expression, clinicopathological features, and survival were examined. RESULTS: HIF-1alpha expression correlated with tumor size (P<0.005), depth of invasion (P=0.018), VEGF expression (P=0.03), and intra-tumor MVD (P<0.005). IGF-2 expression was more prevalent in HIF-1alpha positive than in HIF-1alpha negative tumors and the 5-year survival rate was 58.4% for HIF-1alpha positive patients and 81.5% for HIF-1alpha negative patients (P=0.009). HIF-1alpha expression is an independent prognostic factor in gastric carcinoma (P=0.032). CONCLUSIONS: Overexpression of HIF-1alpha in gastric carcinomas may upregulate its downstream gene products leading to VEGF-mediated angiogenesis, and resulting in a poor prognosis for patients.

Leiomyosarcoma of the greater omentum with liver metastasis: report of a case.

We report herein a rare case of leiomyosarcoma arising from the greater omentum with concomitant liver metastases. A 63-year-old Japanese woman was admitted to our hospital with an elastic-hard mass in the abdomen, but no other symptoms. The findings of several examinations led us to suspect an omental leiomyosarcoma. A laparotomy revealed an elastic hard and foliaceous mass (12.5 x 9.0 x 8.0 cm) arising from the omentum, and six masses in the liver. The omental tumor was extirpated and chemotherapy was administered under the guidance of angiography. The final diagnosis was leiomyosarcoma of the omentum. About 9 months after the operation, multiple liver metastases were found and repeated chemotherapy was given, but without effect. A partial hepatectomy was done, accompanied by microwave coagulation therapy (MCT). She is currently well and asymptomatic, with no signs of recurrence, 1 year after the partial hepatectomy. Thus, surgical resection and MCT were effective against liver metastases of a leiomyosarcoma in this patient.

Effectiveness of preoperative chemotherapy for far advanced gastric cancer.

We herein report a case in which preoperative chemotherapy with cisplatin and 5-fluorouracil was found to effectively treat far advanced gastric cancer invading the pancreas forming a huge mass with regional and distant lymph node metastases. As a result of this treatment regimen, a potentially curative resection was performed which led to a substantially increased survival. The patient was treated with 10 mg of cisplatin and 1000 mg of 5-fluouracil each day preoperatively. After the continuous administration of these drugs for 28 days, the findings of extensive pancreas invasion and lymph node metastases dramatically disappeared. The tumor could be curatively resected by a total gastrectomy with lymph nodes dissection, combined with a distal pancreatectomy and splenectomy. A histological study of a resected specimen showed some cancer cell infiltration remaining within the muscularis propria with fibrous change. There was no evidence of either pancreas invasion or lymph node metastasis. As a result, postoperative adjuvant chemotherapy was performed, 14 months later lymph nodes recurrence was detected and the patient died 20 months after surgery. Our findings suggest that preoperative chemotherapy may thus be effective for the treatment of gastric cancer by both reducing the tumor burden and prolonging survival.

Increased proliferative activity caused by loss of p21(WAF1/CIP1) expression and its clinical significance in patients with early-stage gastric carcinoma.

BACKGROUND: Recurrences of gastric carcinoma are likely to take on a variety forms, even after patients undergo curative resection for early-stage gastric carcinoma. It is important to identify the biologic markers that predict tumor progression and survival in these patients. Proliferating cell nuclear antigen (PCNA) acts as a processivity factor for DNA polymerase delta, which is involved directly in DNA synthesis, and the PCNA level is correlated with the proliferative state of cells. p21(WAF1/CIP1) interacts with PCNA to inhibit DNA synthesis and plays a central role in regulating the cell cycle. The authors investigated patients with early-stage gastric carcinoma to determine the clinical significance of proliferative activity and p21 expression. METHODS: Tissue specimens from 133 Japanese patients with early-stage gastric carcinoma that invaded the submucosal layer were immunostained with a monoclonal antibody against PCNA and p21(WAF1/CIP1), and the correlations between the PCNA labeling index and p21(WAF1/CIP1) expression as well as clinicopathologic factors were investigated. RESULTS: The PCNA labeling index varied from 9.9% to 81.4%, (mean, 31.2%). The incidence of p21 positive expression was 87 of 133 patients (65.4%). The patients with a high labeling index had a significantly higher rate of lymph node metastasis (P < 0.01) and loss of p21(WAF1/CIP1) expression (P < 0.05) compared with the patients with a low labeling index. The 5-year survival rate for patients in the high labeling index group (87.0%) was significantly lower compared with the 5-year survival rate for the patients in the low labeling index group (98.6%; P < 0.05). CONCLUSIONS: Loss of p21(WAF1/CIP1) expression contributes to the amplification of proliferative activity in patients with early-stage gastric carcinoma. Estimation of the proliferative activity of early-stage gastric carcinoma provides information on lymph node metastasis and prognosis. Even after patients undergo curative resection, those with early-stage gastric carcinoma should be followed closely.