Plasma matrix metalloproteinase-9 level is better than serum matrix metalloproteinase-9 level to predict gastric cancer evolution.

PURPOSE: Matrix metalloproteinase-9 (MMP-9) in blood is a promising new tumor marker. The aims of the present study are to compare the usefulness of plasma and serum MMP-9 levels for predicting gastric cancer development, invasion, and survival. EXPERIMENTAL DESIGN: In this nested case-control study, 114 gastric cancer patients and 87 healthy controls were enrolled. MMP-9 levels and activities were quantitatively measured by ELISA assay and zymography. The results were compared with the occurrence, clinicopathologic features, and outcomes of gastric cancer patients. The follow-up time for all patients was at least 5 years. RESULTS: Serum MMP-9 levels were significantly higher than plasma MMP-9 levels. Both plasma and serum MMP-9 levels correlated significantly with active MMP-9 identified by zymography (P = 0.002 and P = 0.048, respectively). Plasma MMP-9 level was significantly elevated in gastric cancer patients when compared with control subjects (P < 0.001). Serum MMP-9 levels did not differ between the groups. Receiver-operator characteristics analysis showed the values of sensitivity (82.5%) and specificity (65.5%) at the maximum accuracy for plasma MMP-9 at >or=60 ng/mL (P < 0.001). Elevated plasma MMP-9 correlated significantly with lymph node metastasis [odds ratio (OR), 3.43; P = 0.019], lymphatic invasion (OR, 7.58; P = 0.009), and venous invasion (OR, 4.14; P = 0.033). Patients with elevated plasma MMP-9 levels had poorer survival rates than those with normal plasma MMP-9 levels (P = 0.038). Serum MMP-9 level did not correlate well with gastric cancer-invasive phenotypes or survival. CONCLUSION: Our results suggest plasma MMP-9 level is a better marker than serum MMP-9 level for predicting gastric cancer development and progression.

Clinicopathological significance of MMP-2 and TIMP-2 genotypes in gastric cancer.

AIMS: Single nucleotide polymorphisms in matrix metalloproteinase-2 (MMP-2) -1306 C/T and tissue inhibitor of metalloproteinase-2 (TIMP-2) -418 G/C abolish the Sp-1 binding site and down-regulate expression of these genes. We aim to elucidate the role of MMP-2 and TIMP-2 in clinicopathological manifestations of gastric cancer. METHODS: We enrolled 240 gastric cancer patients and 283 controls. DNA was extracted from peripheral blood leucocytes. MMP-2 and TIMP-2 genotypes were analysed by PCR-direct sequencing and PCR-RFLP method, respectively. RESULTS: MMP-2 and TIMP-2 genotypes were not associated with gastric cancer development. However, patients with MMP-2 -1306 C/C genotype showed higher risk of lymphatic invasion (odds ratio (OR)=2.77, p=0.01) and venous invasion (OR=2.93, p=0.012). TIMP-2 G/G genotype was associated with serosal invasion (OR=1.89, p=0.009), lymph node metastasis (OR=2.19, p=0.021), lymphatic invasion (OR=2.87, p=0.016) and venous invasion (OR=2.65, p=0.033). CONCLUSION: Our results suggest MMP-2 and TIMP-2 genotypes play a crucial role in gastric cancer invasion, but not with development of gastric cancer.

Elevated plasma osteopontin associated with gastric cancer development, invasion and survival.

OBJECTIVE: Osteopontin (OPN) has been found to be valuable in diagnosis and predicting the prognosis of a variety of malignancies. The aims of the present study are to evaluate the usefulness of plasma OPN level for predicting gastric cancer development, invasion and survival. PATIENTS AND METHODS: One hundred and thirty two gastric cancer patients and 93 healthy controls were enrolled. Real-time quantitative reverse-transcription polymerase chain reaction and immunohistochemical staining were used to detect OPN expression in gastric cancer tissues. Plasma levels of OPN were measured by enzyme-linked immunosorbent assay. Plasma OPN levels were compared with gastric cancer development, clinicopathological features and outcomes. RESULTS: Expression of OPN mRNA was significantly higher in gastric cancer tissues compared with non-tumour tissues. Most OPN immunoactivity was localised to cancer cells. The median plasma OPN level was significantly higher in patients than in controls (p<0.0001), and significantly higher in patients with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Logistic regression showed that high plasma OPN level (greater than 67.3 ng/ml) is significantly associated with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Plasma OPN level demonstrated significant association with patient survival (p<0.0001), especially in the subgroups with invasive phenotypes. On Cox multivariate analysis, elevated plasma OPN level was an independent risk factor for poor survival (p<0.0001). CONCLUSIONS: Elevated plasma OPN level is significantly associated with gastric cancer development, invasive phenotypes and survival. Plasma OPN level may have potential usefulness as a diagnostic and prognostic factor for gastric cancer.

Changes of soluble CD26 and CD30 levels correlate with response to interferon plus ribavirin therapy in patients with chronic hepatitis C.

BACKGROUND: Clearance of hepatitis C virus (HCV) is attributed to host cellular immune responses, in which T helper cells play a critical role. The purpose of the present paper was therefore to study the serial changes of serum soluble markers released from T helper 1 (Th1) and 2 (Th2) and their correlations with treatment responses in chronic hepatitis C patients receiving interferon-alpha plus ribavirin for 24 weeks. METHODS: Serum markers (soluble CD26 and CD30 levels) of T helper cells were quantified before and 6 months after combination therapy in 33 chronic hepatitis C patients and in 20 healthy controls. RESULTS: Compared to healthy controls, chronic hepatitis C patients had significantly lower serum soluble CD26 levels before (140.4 +/- 63.9 ng/mL vs 200.6 +/- 60.3 ng/mL, P < 0.0001) and after (115.9 +/- 32.9 ng/mL vs 200.6 +/- 60.3 ng/mL, P < 0.0001) combination therapy. The level was even lower in those with non-sustained virologic response (non-SVR; 139.0 +/- 50.9 ng/mL vs 117.7 +/- 40.3 ng/mL, P = 0.039). In contrast, soluble CD30 levels at 6 months after combination therapy were significantly lower in patients with SVR than those with non-SVR (6.4 +/- 3.5 U/mL vs 10.4 +/- 5.4 U/mL, P = 0.021). CONCLUSION: Chronic hepatitis C patients have a weak Th1 response as reflected by lower soluble CD26 levels and the levels are even lower in non-sustained responders. In sharp contrast, downregulation of Th2 response with serial changes of soluble CD30 level is associated with successful treatment of HCV infection.

Influence of COX-2 and local cytokine expressions in gastric ulcer mucosa by H. pylori and NSAID.

BACKGROUND/AIMS: H. pylori and NSAIDs are the two most important pathogenic factors in gastric ulcer. NSAIDs and H. pylori share common pathogenic characteristics, but have different effects in modulating COX-2 and local cytokines in gastric ulcer mucosa. This study was designed to explore the influence of COX-2 and local cytokine expressions in gastric ulcer mucosa induced by H. pylori infection and NSAID use. METHODOLOGY: Twenty-three patients were recruited. Sixteen subjects were infected with H. pylori. Fifteen patients used NSAIDs. Gastric biopsy specimens were obtained by endoscopy. COX-2 and local cytokine mRNA expressions were assessed by real-time RT-PCR. RESULTS: COX-2 and local cytokines were over-expressed in gastric ulcer and were positively intercorrelated. H. pylori did not alter COX-2 and local cytokine expressions in gastric ulcer, but induced IL-8 and COX-2 in antral mucosa. NSAIDs inhibited COX-2 expression in gastric ulcer, but had no effect on other local cytokines. COX-2 inhibition by NSAIDs in gastric ulcer was compatible with the findings that NSAIDs delayed gastric ulcer healing. CONCLUSIONS: H. pylori increased IL-8 and COX-2 in the antral mucosa, but did not influence COX-2 and local cytokines in gastric ulcer. NSAIDs inhibited COX-2 in gastric ulcer and delayed gastric ulcer healing.

Long-term results of anti-Helicobacter pylori therapy in early-stage gastric high-grade transformed MALT lymphoma.

BACKGROUND: Several independent clinical studies have reported that Helicobacter pylori eradication therapy could achieve complete remission in some patients with H. pylori-positive early-stage gastric mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: To compare the long-term results of anti-H. pylori therapy in early-stage, gastric low-grade and high-grade transformed MALT lymphoma, two multicenter prospective studies of anti-H. pylori therapy for early-stage gastric lymphoma conducted in Taiwan, one for low-grade MALT lymphoma, with 34 patients enrolled from March 1996 through April 1999, and one for high-grade transformed tumors (diffuse large B-cell lymphoma with features of MALT, DLBCL[MALT] lymphoma), with 24 patients enrolled since June 1995, were directly compared. In both studies, patients generally received 2 weeks of antibiotics and had multiple sequential follow-up endoscopic examinations until complete histologic remission (CR) or disease progression; patients were monitored through January 31, 2004. CR was defined as regression of lymphoid infiltration to Wotherspoon's score of 2 or less on all pathologic sections of endoscopic biopsy specimens. All statistical tests were two-sided. RESULTS: The H. pylori-positive rate among the 34 low-grade patients was 94% (32 of 34). All 24 selected high-grade patients were H. pylori positive. H. pylori was eradicated in 97% (30 of 31) of evaluable H. pylori-positive low-grade patients and in 92% (22 of 24) of high-grade patients, which led to CR in 80% (24 of 30, 95% confidence interval [CI] = 65% to 95%) and 64% (14 of 22, 95% CI = 42% to 86%) of patients, respectively. None of the five patients who were either initially H. pylori negative or had persistent H. pylori infection after antibiotics achieved CR. After median follow-up of more than 5 years in complete responders, tumor recurrence was observed in three (13%) low-grade patients but not in high-grade patients. CONCLUSIONS: Anti-H. pylori therapy may be considered as one of the treatment options for early-stage H. pylori-positive gastric DLBCL(MALT), and large-scale prospective studies to validate its use as first-line therapy for such tumors should be undertaken.

Helicobacter pylori promote gastric cancer cells invasion through a NF-kappaB and COX-2-mediated pathway.

AIM: To examine the effects of Helicobacter pylori (H pylori) infection on the invasiveness of gastric cancer cells, and to elucidate its mechanism. METHODS: Gastric carcinoma cells, MKN-45, were incubated with CagA-positive H pylori, and cell invasion was determined by Matrigel analysis. The expression of matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), and cyclooxygenase-2 (COX-2) were assessed by Western-blot analysis, and transcriptional activation of the COX-2 promoter was examined by measuring luciferase and beta-galactosidase activities. Lastly, the protein-DNA interaction was confirmed by an electrophoretic mobility shift assay. RESULTS: The current studies showed that: (1) incubation of CagA-positive H pylori with MKN-45 cells significantly promotes gastric cancer cells invasion, and this effect is attenuated by pre-treatment with NS-398, a COX-2 inhibitor, or PDTC, a nuclear factor kappaB (NF-kappaB) inhibitor; (2) the induction of MKN-45 cells invasion by H pylori is associated with increases in COX-2, MMP-9, and VEGF protein expression, and co-incubation of NS-398 or PDTC significantly reduces these effects; (3) H pylori infection transactivates COX-2 promoter activity and increases the binding of NF-kappaB to this promoter. CONCLUSION: Our data demonstrate that H pylori infection promotes gastric epithelial cells invasion by activating MMP-9 and VEGF expression. These effects appear to be mediated through a NF-kappaB and COX-2 mediated pathway, as COX-2 or NF-kappaB inhibitor significantly attenuate the invasiveness of gastric cancer cells and the expressions of MMP-9 and VEGF protein.

Atropine-induced HRV alteration is not amended by electroacupuncture on Zusanli.

Acupuncture is known to influence autonomic nervous activity. Acupuncture on Zusanli points has been shown to enhance the regularity of gastric myoelectrical activity and accelerate gastric emptying, partly through the vagal pathway, in dogs. The aim of this study was to evaluate whether atropine-induced autonomic nervous alteration, measured by heart rate variability (HRV), could be amended by electroacupuncture on Zusanli points. HRV measurements were recorded in 15 healthy volunteers before, during and after electroacupuncture. Each subject was studied for three sessions in a randomized sequence, which included electroacupuncture on the Zusanli (St 36) points with or without premedication of atropine and placebo stimulation on a non-acupoint. The analysis of low frequency (LF), high frequency (HF) and LF/HF ratios were compared between different sessions. Serum levels of gastrin, motilin and pancreatic polypeptide (PP) levels were also measured. There was an increase in the LF/HF ratio (indicating increased sympathetic activity) during the post-acupuncture period with 2 Hz of electrical stimulation on the Zusanli acupoints. When IV atropine was used immediately before the electroacupuncture, there was a decrease in the LF power and HF power during the acupuncture and post-acupuncture periods. In addition, there was a significant increase in the LF/HF ratio during the acupuncture and post-acupuncture periods. There was a significant decrease in serum PP in the post-acupuncture period after premedication with IV atropine. In conclusion, atropine-induced HRV change might be mediated via the vagal pathway. However, atropine-induced HRV alteration is not amended by electroacupuncture on Zusanli points.

Abnormal acid reflux in asthmatic patients in a region with low GERD prevalence.

BACKGROUND: A high prevalence of gastroesophageal reflux disease (GERD) in asthmatic patients has been reported from North America and Europe. However, only a few data from Asia are available. This study evaluated the incidence of abnormal gastroesophageal reflux (GER) in asthmatic patients in Taiwan. METHODS: Fifty-six consecutive ambulatory patients with clinically stable asthma (41 men and 15 women; age, 57.7 +/- 12.4 years; range, 24 to 74 years) were evaluated prospectively. All patients underwent esophagogastroduodenoscopy, esophageal manometry, and 24-h esophageal pH monitoring. RESULTS: Twenty-nine patients (51.8%) had abnormal GER, as defined by 24-h esophageal pH monitoring. There were 42 patients without endoscopic evidence of esophagitis, 10 patients with Los Angeles (LA) grade A esophagitis, and 4 patients with LA grade B esophagitis. The esophageal motility function studies revealed 21 patients with normal esophageal motility, 23 patients with ineffective esophageal motility (IEM), and 12 patients with nonspecific esophageal motility disorders other than IEM. Although the lower esophageal sphincter (LES) basal pressure was higher in the patients without GER, the difference was not statistically significant. CONCLUSIONS: Abnormal GER seems to be a clinically significant problem in asthmatic patients in Taiwan. The most common esophageal motility dysfunction is IEM. However, the status of Helicobacter pylori infection plays no role in abnormal GER.

The interaction of H. pylori infection and NSAIDs in cyclooxygenase-2 mRNA expression in gastric antral, corpus mucosa, and gastric ulcer.

BACKGROUND: Although Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the two major causes of gastric ulcer, their interaction remains controversial. We constructed a prospective cohort study to evaluate how these two factors influence the expression of COX-2 mRNA in gastric antral, corpus mucosa, and gastric ulcer. METHODS: Tissues were obtained by endoscopic biopsy of gastric antral, corpus mucosa, and gastric ulcer. The presence of H. pylori was determined by culture or histology using Giemsa stain. NSAID use was assessed by structured questionnaire and medical record review. The expression of COX-2 mRNA was detected by the TaqMan quantitative RT-PCR system. RESULTS: H. pylori infection was associated with increased COX-2 expression only in antral mucosa (0.77 +/- 0.13 vs. 0.31 +/- 0.07, P < 0.01). NSAID use was significantly associated with decreased COX-2 expression in ulcer (4.49 +/- 1.50 vs. 9.82 +/- 2.48, P < 0.05) but not in antral or corpus mucosa. Regarding the interaction between H. pylori and NSAID, we found that H. pylori infection was associated with increased COX-2 expression in antral mucosa for both NSAID users and nonusers. In NSAID users, H. pylori infection was not associated with increased COX-2 expression in ulcer edge. CONCLUSION: H. pylori infection was associated with increased COX-2 expression in gastric antral mucosa for both NSAID users and nonusers, but not in gastric ulcer, where the effect of NSAID inhibition plays a major role. With these observations, we can interpret indirectly that H. pylori eradication does not interfere with gastric ulcer healing in NSAID users.

Diffuse esophageal leiomyomatosis with a pedunculated polyp.

Although leiomyomas are the most common benign tumors of the esophagus, esophageal leiomyomatosis is a rare pathological entity, and pedunculated presentation is even rarer. A 61-year-old man was found, incidentally, to have an esophageal tumor on a survey of chest computed tomography (CT) examination for a pulmonary nodule. Endoscopy disclosed a pedunculated polyp covered by nearly normal esophageal mucosa, with surrounding annular extension of a submucosal elevation. Endoscopic ultrasonography (EUS) revealed a hypoechoic tumor, with a maximum diameter of 3 cm originating from the thickened muscularis mucosa layer. The underlying muscularis propria layer was also prominently thickened. The polypoid lesion was then removed by endoscopic resection with wire-loop ligation, followed by snare electrocoagulation. The pathological diagnoses of the polyp and the surrounding submucosal lesions were both leiomyoma. Diffuse esophageal leiomyomatosis was suspected in this situation because of the characteristic pathological distribution. In this patient, the EUS findings corresponded well to the characteristic features of diffuse esophageal leiomyomatosis noted in previous reports, and this was of great help for the diagnosis, in addition to the endoscopic findings. This case report is presented with a particular focus on the problems associated with accurate diagnosis.

Effect of Helicobacter pylori infection on intragastric acidity in patients with reflux esophagitis.

BACKGROUND: The effect of Helicobacter pylori infection on intragastric acidity in patients with reflux esophagitis was investigated. METHODS: Esophageal motility and 24-h intragastric acidity were assessed in endoscopy-proven reflux esophagitis patients with ( n = 50) and without ( n = 50) H. pylori infection. RESULTS: Most of the patients had a mild degree of esophagitis. There was no difference in the age, sex, or body mass index (BMI) between patients with and without H. pylori infection. The 24-h intragastric pH monitoring showed less acidity in patients with H. pylori infection than in those without H. pylori infection (median pH, 1.6 +/- 0.3 vs 1.4 +/- 0.1, with vs without H. pylori infection; P < 0.01). No difference in the patterns of esophageal motility dysfunction was noted between these two groups of patients. CONCLUSIONS: Patients with reflux esophagitis and H. pylori infection had less intragastric acidity than those without H. pylori infection. However, the extent of acid suppression was insufficient to protect the esophagus from acid injury. In addition, the degree of esophageal motility dysfunction was similar in both groups. Therefore, H. pylori infection may play no role in the pathogenesis of reflux esophagitis.

Hepatitis B virus transmission and hepatocarcinogenesis: a 9 year retrospective cohort of 13676 relatives with hepatocellular carcinoma.

BACKGROUND/AIMS: Familial clustering of hepatitis B virus (HBV) infection is related to perinatal transmission, and is the main cause of familial-type hepatocellular carcinoma (HCC). The route of HBV transmission differs between the children and siblings of patients with HCC. This study examined the differences in HBV carrier rates and HCC-related mortality between two generations in HCC families. METHODS: From 1992 to 1997, relatives of individuals with HCC were screened prospectively with ultrasonography, alpha-fetoprotein, liver biochemistry tests and viral markers. Total HCC-related deaths during a 9-year period were compared between the generations of index patients and their children. RESULTS: The study included a total of 13676 relatives in two generations. More HCC-related deaths occurred in the index patient generation than in the child generation. Furthermore, children of female index patients had higher rates of liver cancer related mortality than children of male index patients. The same was true when the analysis was limited to male HBV carriers. The prevalence of HBsAg in the offspring of HBsAg positive mothers was 66% in the child generation and 72% in the index patient generation. These high prevalences indicated high maternal HBV replication status. CONCLUSIONS: Perinatal transmission and maternal viral load are important risk factors in hepatocarcinogenesis.

Tc-99m MIBI liver imaging for hepatocellular carcinoma: correlation with P-glycoprotein-multidrug-resistance gene expression.

BACKGROUND/AIMS: Technetium-99m methoxyisobutyl isonitrile (MIBI) has been shown to be useful in identifying several types of tumors, such as breast, lung and thyroid cancers. There are only a few reports in the literature regarding Tc-99m MIBI uptake in hepatocellular carcinoma, and the results are conflicting. The aim of this study was to investigate the relationship between Tc-99m MIBI accumulation in patients with hepatocellular carcinoma and the gene expression of P-glycoprotein-multidrug-resistance. METHODOLOGY: Twenty-two patients with hepatocellular carcinoma were enrolled in this study. Tc-99m MIBI imaging was performed 10 minutes after intravenous injection of 20 mCi Tc-99m MIBI. All patients had liver biopsy or surgery within 1 week of MIBI imaging. Immunohistochemical study of the biopsy or resected hepatocellular carcinoma specimens was performed using the anti-human P-glycoprotein antibody. RESULTS: On Tc-99m MIBI imaging, 20 of 22 (90.9%) patients with hepatocellular carcinoma showed negative Tc-99m MIBI uptake in tumor lesions, whereas only 2 patients showed positive Tc-99m MIBI uptake in tumor lesions. P-glycoprotein expression was observed in 13 of 20 (65%) patients with negative Tc-99m MIBI uptake, but in the 2 patients who showed positive Tc-99m MIBI uptake in tumor lesions, P-glycoprotein expression was negative. CONCLUSIONS: Tc-99m MIBI SPECT is a useful noninvasive method for predicting the expression of P-glycoprotein-multidrug-resistance gene in hepatocellular carcinoma patients.

Hepatic abscess caused by Aspergillus fumigatus infection following splenectomy and immunosuppressive therapy.

Hepatic abscess caused by Aspergillus fumigatus infection is rare. The incidence of fungal hepatic abscess has recently increased. We report a case of Aspergillus fumigatus infection in a 66-year-old man with aplastic anemia who presented with intermittent high fever. He had received splenectomy about 2 years before this admission followed by treatment with anti-human thymocyte globulin, corticosteroids, and cyclosporin. Abdominal sonography and computerized tomography scan of the liver revealed a hepatic abscess and empiric broad-spectrum antibiotics were administered, but fever persisted. Culture of abscess aspirate yielded Aspergillus fumigatus. Amphotericin B was administered, but the patient died of sepsis. With the increasing number of immunocompromised patients, various fungal infections, including Aspergillus fumigatus, are increasingly common, and this infection can be very serious with fatal outcome. Alertness to the possibility that fungal infection may be present when an immunocompromised patient with hepatic abscess presents in hospital is important to decreasing morbidity and mortality.

Characteristics of hepatocellular carcinoma in hemodialysis patients in hepatitis B endemic area.

BACKGROUND/AIMS: Hepatocellular carcinoma is one of the most common malignancies in Taiwan, a hepatitis B endemic area. In this study, we aimed to evaluate the characteristics of hepatocellular carcinoma in patients receiving hemodialysis, as this patient group is at high risk for malignancy. METHODOLOGY: From October 1991 to September 1997, thirteen patients receiving hemodialysis and diagnosed with hepatocellular carcinoma were enrolled in this retrospective study. Patients' clinical course, laboratory data, image study and treatment were evaluated. RESULTS: Among these 13 patients, hepatitis B virus related in 6 and hepatitis C virus related in 7. There was no statistical significance in serum levels of asparate aminotransferase, alanine aminotransferase, bilirubin and alpha-fetoprotein between hepatitis B virus and hepatitis C virus related hepatocellular carcinoma. Hepatitis B virus related hepatocellular carcinoma had a shorter mean dialysis period (29.67 +/- 22.18 vs. 87.86 +/- 79.90 months, P = 0.25) and mean duration from beginning hemodialysis to diagnosis of hepatocellular carcinoma (17.16 +/- 26.94 vs. 76.08 +/- 65.69 months, P = 0.05), but there was no statistical significance. In the area of treatment, the survival curves of the treatment (hepatic resection and/or transcatheter arterial chemoembolization) group and supportive group were compared by log-rank test and there was no statistical significance for these two groups (P = 0.69). CONCLUSIONS: Both hepatitis B virus and hepatitis C virus are equally important for hepatocellular carcinoma in hemodialysis patients in hepatitis B endemic Taiwan. The acquisition of hepatitis B virus or hepatitis C virus might be not related to hemodialysis. Periodic screening with ultrasonography and serum alpha-fetoprotein is necessary among hemodialysis patients with evidence of hepatitis B virus or hepatitis C virus infection.

Clinical significance and prediction factors of gastric varices in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma is part of the natural history of liver cirrhosis. Gastrointestinal bleeding and hepatic failure are the leading causes of death in hepatocellular carcinoma patients. With gastrointestinal bleeding, variceal bleeding is the most prominent, and most variceal bleeding is of esophageal origin. Gastric varices bleeding is often a massive and severe bleeding episode. The role of gastric varices among patients with hepatocellular carcinoma remains to be clarified. In this study, we aimed to evaluate the prevalence, clinical significance and prediction of gastric varices in patients with hepatocellular carcinoma. METHODOLOGY: From 1998 to 2000, we reviewed 304 patients with hepatocellular carcinoma receiving upper gastrointestinal endoscopic examinations. Patients' clinical characteristics, physical findings, laboratory data, image studies, endoscopic examinations and treatment were reviewed. RESULTS: Among 304 patients with HCC, twenty-one (6.9%) had gastric varices among 304 patients with hepatocellular carcinoma. The location of gastric varices were the posterior wall in 12 (57%), the lesser curvature in 1 (5%), the greater curvature in 4 (19%) and the fundus in 4 (19%). Three (14%) of these 21 patients with hepatocellular carcinoma and gastric varices had clinical evidence of bleeding. One of them died due to uncontrollable bleeding. Child-Pugh classification, hepatic encephalopathy, portal vein or splenic vein dilatation, ascites, splenomegaly, albumin level, prothrombin time and platelet count were significantly different between hepatocellular carcinoma patients with gastric varices and without gastric varices under the univariate analysis. Ascites (Odds ratio: 5.45; 95% confidence interval: 2.12-14.01) and portal vein or splenic vein dilatation (Odds ratio: 4.38; 95% confidence interval: 1.77-10.86) were the two most important predictors under the stepwise logistic regression analysis. CONCLUSIONS: The prevalence of gastric varices in patients with hepatocellular carcinoma is 6.9% and the risk of bleeding is low in this study. The Predictors of gastric varices among hepatocellular carcinoma are related to liver cirrhosis, Child-Pugh classification, hepatic encephalopathy, portal vein or splenic vein dilatation, ascites, splenomegaly, albumin level, prothrombin time and platelet count.

Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor.

BACKGROUND/AIMS: To study and review the clinical manifestations, microbiology, comorbidity, and diagnosis of liver abscess after transarterial chemoembolization for malignant hepatic tumor. METHODOLOGY: We retrospectively reviewed 1374 patients who underwent 2581 transarterial chemoembolization procedures due to malignant hepatic tumors over an 8-year period. RESULTS: 7 patients had liver abscess after transarterial chemoembolization. The incidence was 0.27% (7/2581). Hepatocellular carcinoma was diagnosed in all 7 patients, whose liver function was classified as stage A by the Child-Pugh criteria. The clinical manifestations were intermittent fever, abdominal pain, and leukocystosis. All the patients had hyperechoic spots with reverberative shadows on sonograms or low attenuation areas with different Hounsfield units on computed tomography scan, which expressed the 100% incidence (7 of 7) of gas-forming abscesses. Percutaneous drainage or aspiration was done in 6 patients. One received laparotomy with local debridement due to suspicious organ rupture. The pus culture showed Gram-negative bacteria in all patients. Blood cultures were positive in only 3 of 7 patients (43%). No patients died of liver abscess after aspiration, drainage, or debridement of abscess combined with parenteral antibiotic treatment. Biliary tract diseases, found in 4 patients, were the most common comorbidity. CONCLUSIONS: Liver abscess after transarterial chemoembolization is a very rare complication, which usually develops in patients with biliary tract disease. Gram-negative bacteria are the main pathogens. The incidence of gas formation is higher after transarterial chemoembolization than in the general population. However, the prognosis is good after adequate clearance of pus and antibiotic treatment.

The effect of different frequency electrical acu-stimulation on gastric myoelectrical activity in healthy subjects.

BACKGROUND/AIMS: Acupuncture has been used to treat gastrointestinal symptoms in oriental countries for many years. The underlying mechanism is still not fully understood. METHODOLOGY: Fifteen healthy male volunteers were enrolled into this study. A cutaneous electrogastrography recording was obtained. Two frequencies (2 Hz and 100 Hz) of electrical stimulation were applied to Zusnali or Shousanli point in different sessions. Another non-acu-point (2 cm lateral to Zusanli) without electrical stimulation was used for a control study. RESULTS: There was a significant increase in the percentage of normal frequency during 2 Hz of electrical stimulation on Zusnali (baseline vs. acupuncture, 82.49 +/- 12.87% vs. 93.18 +/- 8.40%, p < 0.01). The percentage of normal frequency did not change significantly, during or after acupuncture, with 100 Hz of electrical stimulation on Zusnali, or 2 Hz and 100 Hz of electrical stimulation on Shousanli. In addition, the percentage of tachygastric frequency and power ratio also changed significantly during 2 Hz of electrical stimulation on Zusnali. However, the change in the percentage of bradygastria and dominant frequency was not statistically significant among all five study sessions during each stage. CONCLUSIONS: The results of this study demonstrated that electrical stimulation, with a frequency of 2 Hz, on Zusanli might enhance the regularity of gastric myoelectrical activity. The effect of acupuncture on gastric myoelectrical activity was acu-point-specific, and that effect was observed with 2 Hz but not 100 Hz electrical stimulation.

Effect of P-glycoprotein and multidrug resistance associated protein gene expression on Tc-99m MIBI imaging in hepatocellular carcinoma.

P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP) expressions as well as Tc-99m methoxisobutylisonitrile (MIBI) images were assessed in 25 patients hepatocellular carcinoma (HCC). Tc-99m MIBI imaging was performed 10 minutes after intravenous injection of 20 mCi Tc-99m MIBI. Using immunohistochemical staining, 60% of the HCC lesions showed positive for Pgp and 64% showed positive for MRP. In 3 patients with MIBI uptake, immunohistochemical study of tumor tissue showed no Pgp stained cells. Nevertheless, they were all positive for MRP. The result of Tc-99m MIBI imaging is more related to the expression of Pgp than MRP gene. It is possible that other membrane transporters as well as Pgp and MRP are involved in the efflux of Tc-99m MIBI.