Rice prolamin extract ameliorates acute murine colitis by inhibiting nuclear factor-kappa B and modulating intestinal apoptosis and cell proliferation.

We investigated the impact of rice prolamin extract (RPE) on lipopolysaccharide (LPS)-induced nuclear factor (NF)-κB signalling in intestinal epithelial cells and macrophages, and determined the therapeutic efficacy of RPE in acute murine colitis. The effect of RPE on LPS-induced NF-κB signalling and proinflammatory gene expression was evaluated by reverse transcription-polymerase chain reaction (RT-PCR), Western blotting, immunofluorescence and electrophoretic mobility shift assay (EMSA). The in-vivo efficacy of RPE was assessed in mice with 3% dextran sulphate sodium (DSS)-induced colitis. Apoptotic and cellular proliferative activities were evaluated by immunostaining with cleaved caspase-3 and proliferating cell nuclear antigen (PCNA) antibodies. RPE inhibited LPS-induced expression of monocyte chemotactic protein (MCP)-1, interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha and LPS-induced NF-κB signalling in intestinal epithelial cells and macrophages. RPE-fed, DSS-exposed mice showed less weight loss, longer colon length and lower histological score compared to control diet-fed, DSS-exposed mice. Immunostaining analysis revealed a significant decrease of cleaved caspase-3 positive cells in RPE-fed, DSS-exposed mice compared to DSS-exposed mice. Also, the number of PCNA-positive cells within intact colonic crypts decreased significantly in RPE-fed, DSS-exposed mice compared to control diet-fed, DSS-exposed mice. DSS-induced NF-κB signalling was inhibited by RPE. RPE ameliorates intestinal inflammation by inhibiting NF-κB activation and modulating intestinal apoptosis and cell proliferation in an acute murine colitis.

Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study.

BACKGROUND AND STUDY AIMS: Post-polypectomy coagulation syndrome (PPCS) is a well known complication of colonoscopic polypectomy. However, no previous studies have reported on the clinical outcomes or risk factors of PPCS. The aim of the current study was to analyze the clinical outcomes and risk factors of PPCS developing after a colonoscopic polypectomy. PATIENTS AND METHODS: Data for all patients who underwent colonoscopic polypectomies and required hospitalization in nine university hospitals were analyzed retrospectively. The incidence, clinicopathological characteristics, and clinical outcomes of PPCS cases were examined. Additionally, patients who developed PPCS were compared with controls who were matched by age and sex, in order to assess for possible risk factors. RESULTS: The rate of PPCS that required hospitalization after colonoscopic polypectomy was 0.7/1000. All patients with PPCS were treated medically without the need for surgical interventions. The median durations of therapeutic fasting, hospitalization, and antibiotic use were 3 days, 5.5 days, and 7 days, respectively. The rates of major PPCS and mortality were 2.9 % and 0 %, respectively. On multivariate analysis, hypertension (OR = 3.023, 95 %CI 1.034 - 8.832), large lesion size (OR = 2.855, 95 %CI 1.027 - 7.937), and non-polypoid configuration (OR = 3.332, 95 %CI 1.029 - 10.791) were found to be independent risk factors related to the development of PPCS. CONCLUSIONS: In this study, the rates of major PPCS and mortality were only 2.9 % and 0 %, respectively. Hypertension, large lesion size, and non-polypoid configuration of the lesion were independently associated with PPCS. Therefore, patients may be reassured by the excellent prognosis of PPCS, while endoscopists should be especially careful when performing colonoscopic polypectomies in patients with hypertension or large and non-polypoid lesions.

Organised haematoma of the maxillary sinus in patients with chronic renal failure.

OBJECTIVE: Organised haematoma of the maxillary sinus may be present in chronic renal failure patients, because these patients are at high risk of haemorrhage. CASE REPORTS: We present two cases of organised haematoma of the maxillary sinus in patients with chronic renal failure. CONCLUSION: A diagnosis of organised haematoma of the maxillary sinus should be considered when a patient with a history of chronic renal failure develops unilateral, recurrent epistaxis and nasal obstruction.

Fungus ball within a mucocele of the sphenoid sinus and infratemporal fossa: case report with radiological findings.

OBJECTIVE: We report an extremely rare case of a fungus ball within a mucocele of the sphenoid sinus and infratemporal fossa. CASE REPORT: A 62-year-old woman was referred for evaluation of a mass lesion in the left sphenoid sinus and infratemporal fossa. Endoscopic examination of the nasal cavity was unremarkable. Computed tomography showed a non-enhancing, expansile mass with calcifications in the sphenoid and infratemporal fossa; T2-weighted magnetic resonance imaging revealed marked hypointense signals within the sphenoid sinus mass, with an intermediate signal intensity. A presumptive diagnosis of a mucocele was made. During surgery, a profuse amount of yellow fluid was drained from the mucocele. Clay-like material was noted within the mucocele, corresponding to the hypointense magnetic resonance imaging signals; this was identified as aspergillus on histopathological examination. Radiological findings for a fungus ball within a mucocele can be similar to those for allergic fungal sinusitis, which shows mixed low and high attenuation on computed tomography and low-signal intensity on T2-weighted magnetic resonance imaging, within an expansile, cystic lesion. CONCLUSION: Although an association between a fungus ball and a mucocele is rare in the paranasal sinuses, this disease entity should be considered in the differential diagnosis of expansile, cystic sinus lesions.

A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions.

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly in the proximal stomach. Mechanical endoscopic methods have recently become the standard therapeutic approach. However, there have been few studies comparing the efficacy of different mechanical endoscopic methods in treating gastric Dieulafoy's lesions. This study was therefore carried out to compare the hemostatic efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in the treatment of bleeding gastric Dieulafoy's lesions. PATIENTS AND METHODS: Between January 2002 and October 2003, 26 consecutive patients with bleeding gastric Dieulafoy's lesions were prospectively enrolled and were randomly assigned to undergo EBL (13 patients) or EHP (13 patients). Demographic characteristics, endoscopic variables, and outcome parameters, including rates of hemostasis and recurrent bleeding, were analyzed. RESULTS: One O-ring was applied in each case in the EBL group, and the median number of hemoclips applied was one (range one to four) in the EHP group. There were no significant differences between the groups with regard to age, sex, presence of shock, initial hemoglobin level, coagulopathy, concurrent diseases, location of the lesion, type of bleeding stigmata, blood transfusion requirements, or hospitalization periods. Primary hemostasis was achieved in all 26 patients. There was one case of recurrent bleeding in each group; secondary hemostasis was achieved with EBL in one of these patients and by endoscopic epinephrine injection in the other. There were no second episodes of recurrent bleeding, no procedure-related complications, no cases in which surgery was needed, and no bleeding-related deaths in either group. CONCLUSIONS: In this small study, no differences were detected in the efficacy or the safety of EBL vs. EHP in the management of bleeding gastric Dieulafoy's lesions.

Endoscopic band ligation for control of acute peptic ulcer bleeding.

BACKGROUND AND STUDY AIMS: The use of endoscopic band ligation (EBL) is being extended to treat various causes of upper and lower gastrointestinal bleeding. The aim of this study was to evaluate the usefulness of EBL for control of acute peptic ulcer bleeding and to define the lesions that are most suitable for this technique. PATIENTS AND METHODS: 19 patients with major stigmata of acute peptic ulcer bleeding were treated using EBL; 11 patients had active bleeding and eight patients had a nonbleeding visible vessel. RESULTS: The site of acute peptic ulcer bleeding was the stomach in 12 patients, the duodenum in four patients, and Billroth II anastomosis in three. Initial hemostasis was achieved in 19 patients (100 %) in a single session. There were no rebleeding episodes in any of the patients, and there was no bleeding-related or procedure-related death. During long-term outpatient follow-up, bleeding did not recur. CONCLUSIONS: EBL is an effective and safe endoscopic treatment for small-sized nonfibrotic acute peptic ulcer bleeding. Larger studies in patients with acute peptic ulcer bleeding are needed to confirm these promising results.

The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions.

BACKGROUND AND STUDY AIMS: Dieulafoy lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly from the proximal stomach. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. However, the effectiveness of various endoscopic modalities in treating bleeding Dieulafoy lesion has been little studied. This study was therefore done to compare the hemostatic efficacy of endoscopic hemoclipping and epinephrine injection therapy. PATIENTS AND METHODS: Between January 1998 and December 2001, a consecutive series of 32 patients with bleeding Dieulafoy lesion underwent endoscopic treatment. They were randomly treated either by endoscopic epinephrine injection therapy (n = 16) or by hemoclipping (n = 16). We compared mortality rate, primary hemostasis rate, and rebleeding rate between two groups. RESULTS: There was no bleeding-related death in either group. There was no significant difference in primary hemostasis rates between the hemoclipping group (93.8 %) and epinephrine injection group (87.5 %, P = 1.00). There was a trend toward a lower rate of need for multiple endoscopic sessions to achieve permanent hemostasis in the hemoclipping group compared with the epinephrine injection group (6.3 % vs. 31.3 %, P = 0.086). Hemoclipping was significantly more effective in preventing recurrent bleeding than epinephrine injection therapy (0 % vs. 35.7 %, P < 0.05). With regard to lesion site, hemoclipping was significantly more effective in preventing recurrent bleeding of gastric body Dieulafoy lesion than epinephrine injection therapy (0 % vs. 50 %, P < 0.05). CONCLUSIONS: Bleeding from Dieulafoy lesion was well controlled by therapeutic endoscopic procedures. Hemoclipping was more effective for Dieulafoy lesion than epinephrine injection therapy, with less need for subsequent endoscopy.

Internal hernia presenting as obstructive jaundice and acute pancreatitis.

We report the first case of obstructive jaundice and acute pancreatitis caused by herniation of the small bowel through the foramen of Winslow in a 45-year-old man. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed dilated small-bowel loops positioned in the gastrohepatic space, dilatation of the gallbladder and both intrahepatic bile ducts, and mild swelling of the pancreas. A small-bowel series revealed a cluster of small-bowel loops in the mid-upper abdomen, with displacement of the stomach to the left. At laparotomy, there was an internal herniation of jejunal loop through the defect of gastrocolic ligament into the lesser sac and finally passing through the foramen of Winslow. The common bile duct was compressed externally by the herniated bowel and the pancreas was mildly swollen. To the best of our knowledge, these complications of internal hernia have not been reported previously.

Changes in the E-cadherin-catenin complex expression in early and advanced gastric cancers.

BACKGROUND/AIM: In various human cancers, dysfunction of the E-cadherin-catenin complex is associated with a decrease in cellular and tissue differentiation and with higher invasive and metastatic potentials. Since advanced gastric cancers are thought to evolve from early gastric cancers, we investigated whether differences of the E-cadherin-catenin complex expression can be observed between early and advanced gastric cancers. METHODS: We have used an immunohistochemical technique to localize E-cadherin and alpha-, beta-, and gamma-catenins in 114 formalin-fixed, paraffin-embedded tissue blocks: 57 from patients with early gastric cancer and 57 from patients with advanced gastric cancer. RESULTS: The immunoreactivity of E-cadherin and alpha-, beta-, and gamma-catenins was expressed by normal gastric epithelial cells with strong membranous staining at the intercellular border. Reduced expression of E-cadherin and alpha-, beta-, and gamma-catenins occurred in a considerable proportion of both cancer groups. However, no significant difference was seen between early and advanced cancer groups. In the early cancer group, reduced expression of E-cadherin and alpha-, beta-, and gamma-catenins correlated with diffuse type of cancer and poor differentiation. However, in the advanced cancer group, reduced expression of the three adhesion molecules, but not beta-catenin, correlated with diffuse type of cancer and poor differentiation. The expression of E-cadherin and alpha-, beta-, and gamma-catenins did not correlate with depth of invasion or lymph node metastases in both cancer groups. CONCLUSION: These results suggest that alterations of the E-cadherin-catenin complex may be induced at an early stage of gastric tumorigenesis and may be associated with poorly differentiated and diffuse-type pathways in gastric tumorigenesis.

Massive gastrointestinal bleeding caused by ectopic pancreas mimicking jejunal tumor.

BACKGROUND: Ectopic pancreas is usually an incidental finding at surgery or autopsy and rarely produces clinical symptoms. But it is capable of producing symptoms, depending on its location, size and involvement of the overlying mucosa. CASE REPORT: We report a case with massive gastrointestinal bleeding from ectopic pancreas mimicking jejunal tumor, confirmed by emergency operation. A 40-year-old male was admitted to Chonnam National University Hospital with a 2-day history of melena. A technetium-99m-labeled RBC scan showed massive radioactivity in loops of small bowel due to active bleeding. Superior mesenteric angiography revealed a hypervascular stained mass supplied by proximal jejunal branch. A computed tomographic scan of abdomen revealed an enhancing mass in the proximal jejunum. At emergency operation, bleeding from the center of the mass was found situated approximately 30 cm from the Treitz ligament. Segmental resection of the involved jejunum and end-to-end anastomosis were performed. Histologic examination of resected specimen revealed an ectopic pancreas. CONCLUSION: So far, there have been no case reports of massive gastrointestinal bleeding from ectopic pancreas mimicking jejunal tumor as described in our case. In every patient in whom ectopic pancreas can definitely be seen to cause clinical symptoms including gastrointestinal bleeding, the lesion should be excised.

Massive gastrointestinal bleeding from jejunal varices.

We report a patient with massive gastrointestinal bleeding from jejunal varices, confirmed by emergency laparotomy. A 54-year-old woman was admitted to Chonnam National University Hospital with a 5-day history of melena with hematochezia. Fifteen years previously, she had undergone cholecystectomy for gallstone. Seven years previously, she had undergone an operation because of possible common bile duct stone. The details of this operation were not known. Upper gastrointestinal endoscopy revealed no varices in the esophagus, stomach, and proximal duodenum. Colonoscopy demonstrated black-colored blood clots throughout the colon. A technetium-99m-labeled red blood cell (RBC) scan showed active proximal small bowel bleeding. Abdominal aortic angiography revealed mesenteric varices in the upper abdomen, but no active bleeding source was recognized. Because of the patient's continued massive gastrointestinal bleeding despite medical therapy, emergency laparotomy was performed. We found evidence of micronodular cirrhosis of the liver and an apparent Roux-en-Y anastomosis. There were numerous collateral variceal vessels in the jejunal limb with the liver and abdominal wall. Segmental resection of the involved jejunum and end-to-end anastomosis were perdilated formed. Histologic examination revealed submucosal veins with mucosal erosion.

Expression of tissue inhibitors of metalloproteinases (TIMPs) in gastric cancer.

Matrix metalloproteinases (MMPs) are one of the major classes of proteolytic enzymes involved in tumor invasion and metastasis, being inhibited by naturally occurring tissue inhibitors of metalloproteinases (TIMPs). Sixty-five patients who underwent surgery for gastric cancer in 1992 at Chonnam National University Hospital were selected for this study. The primary selection criteria were the availability of formalin-fixed and paraffin-embedded blocks and sufficient clinical follow-up for tumor-specific survival analysis. In this study, we examined the expression of TIMP-1 and TIMP-2 in human gastric cancer tissue by in situ hybridization and immunohistochemistry, and the correlation between their expression and clinicopathological parameters. TIMP-1 and TIMP-2 expressions were detected predominantly in the peritumor stromal cells rather than tumor cells themselves. Immunohistochemical stainings were concordant with the result obtained by in situ hybridization. The intensity of TIMP-1 immunohistochemical stromal staining correlated with tumor stage (P = 0.009) and patient survival (P = 0.025). However, the intensity of TIMP-2 immunohistochemical stromal staining did not correlate with tumor stage (P = 0.339) and patient survival (P = 0.474). The correlation between the increased TIMP-1 expression and cancer stage noted in this study reflects a role of TIMP-1 in predicting the aggressive behavior of gastric cancer. TIMP-2 expression did not correlate with clinicopathological parameters. However, expression of TIMP-1 and the possible additional value of TIMP-2 should be further explored in determining the prognosis of gastric cancer.

Prognostic significance of E-cadherin/catenin complex expression in gastric cancer.

Abnormal expression of E-cadherin/catenin complex in cancer has been associated with poor differentiation and acquisition of invasiveness, suggesting a possible role of this protein as an invasion suppressor. In this study, we conducted an immunohistochemical investigation of all components of the E-cadherin/catenin complex in 65 gastric cancer patients. Abnormal expression of E-cadherin and, alpha- and gamma-catenin occurred more frequently in diffuse than in intestinal type of gastric cancer, and correlated with poor differentiation. Abnormal expression of E-cadherin and beta-catenin correlated with poor survival. Abnormal expression of all four components of the complex was associated with poorly differentiated and diffuse-type carcinoma, and poor survival. In the multivariate analysis, abnormal expression of the E-cadherin/catenin complex was not an independent prognostic factor. These results suggest that the E-cadherin/catenin complex may be a useful marker of differentiation and prognosis in gastric cancer. Further studies are warranted to clarify the impact of the E-cadherin/catenin complex on prognostic factor of gastric cancer.

Expression of tissue inhibitors of metalloproteinases (TIMPs) in hepatocellular carcinoma.

BACKGROUND: Matrix metalloproteinases (MMPs) have been implicated in the remodelling of extracellular matrix (ECM), including basement membrane. ECM remodelling is associated with pathological processes, including hepatic fibrosis, tumor invasion and metastasis. Tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 were known to inhibit MMP-9 and MMP-2, respectively. In the present study, we examined the expression of TIMP-1 and TIMP-2 in surgical specimen pairs of hepatocellular carcinoma and nontumoral liver and the correlation between their expression and clinicopathological characteristics. METHODS: The localization of both transcripts and protein of TIMP-1 and TIMP-2 was studied by using in situ hybridization and immunohistochemistry. RESULTS: TIMP-1 and TIMP-2 mRNA transcripts were found in tumor cells, hepatocyte, sinusoidal cells, endothelial cells and stromal cells. Signal intensity of TIMP-1 was stronger than that of TIMP-2. The results of immunohistochemical stainings were concordant with those obtained by in situ hybridization. Expression of TIMP-1 and TIMP-2 was observed in tumorous tissue, in nontumorous tissue and in the portions of the tumors adjacent to the capsules. However, a clear difference in TIMP-1 and TIMP-2 mRNA expression was not observed among the three tissue types. The intensity of TIMP-2 expression was generally weaker than that of TIMP-1, and the intensity of TIMP-1 and TIMP-2 mRNA expression did not correlate with variable clinicopathological characteristics. CONCLUSION: TIMPs was expressed in tumor cells and many cell types of the nontumoral liver. Further investigations for TIMPs' unknown functional role are needed.

Clinical results of the transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of variceal bleeding.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) has been popularized for the treatment of refractory variceal bleeding. The aim of this study was to assess the safety and long-term effect of TIPS in the treatment of variceal bleeding that is not controlled with pharmacological and endoscopic treatment. METHODS: Thirty-six patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) due to refractory variceal bleeding were included in the study. The effectiveness of portal decompression and bleeding control was evaluated. Upper gastrointestinal endoscopy was performed to analyse the degree of varices and portal hypertensive gastropathy (PHG) before TIPS procedure and one to three weeks after TIPS. Angiography was performed in surviving patients, if bleeding recurred, or if ultrasonography or endoscopy suggested stent dysfunction. RESULTS: TIPS were successfully placed in 36 of 38 patients (94.6%). TIPS achieved hemostasis of variceal bleeding in 34 patients (94.4%). Portal venous pressure decreased from an initial average of 28.7 +/- 7.9 to 23.2 +/- 9.4 mmHg after TIPS (p < 0.05). The portosystemic pressure gradient was significantly decreased from 15.5 +/- 6.3 to 7.8 +/- 4.1 mmHg (p < 0.01). The degree of esophagogastric varices and PHG was significantly improved after TIPS. The total length of follow-up was from one day to 54 months (mean: 355 days). The actuarial probability of survival was 83% at one year and 74% at two years. Overall, 16 episodes of stent dysfunction were diagnosed during follow-up. Stent revision by means of angioplasty was successfully performed in 14 of these episodes. CONCLUSION: TIPS is an effective and reliable nonoperative means of lowering portal pressure. This procedure has proved useful in the management of acute variceal bleeding refractory to endoscopic treatment. Surveillance by ultrasonography, endoscopy, and angiographic intervention is useful for the maintenance of shunt patency.

Role of tissue inhibitors of metalloproteinases (TIMPs) in colorectal carcinoma.

Increased production of matrix metalloproteinases (MMPs) has been associated with increases in invasive and metastatic potential in many types of human carcinoma. Tissue inhibitors of metalloproteinase (TIMP)-1 inhibits most interstitial collagenases and MMP-9. TIMP-2 binds specifically and noncovalently to the pro-form of MMP-2 and inhibits its enzyme activity. In this study, we examined TIMP-1 and TIMP-2 expressions in relation to clinicopathological variables in colorectal carcinoma with in situ hybridization and immunohistochemistry. TIMP-1 and TIMP-2 expressions were localized overwhelmingly to pericancer stromal cells, while malignant and normal mucosal cells were weak or negative. Strong stromal TIMP-1 immunoreactivity correlated with Dukes' stage (p=0.022), status of lymph node metastasis (p=0.044) and poor survival (p= 0.005). The degree of immunohistochemical staining of TIMP-2 did not correlate with all clinicopathological variables. The correlation between enhanced TIMP-1 expression and advanced stage and poor survival suggest a growth promoting activity of TIMP-1 in colorectal carcinoma.

A case of xanthogranulomatous cholecystitis.

Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal or diffuse destructive inflammatory disease of the gallbladder that is assumed to be a variant of conventional chronic cholecystitis. A 36-year-old male was admitted to Chonnam National University Hospital with a 10-day history of right upper quadrant pain with fever. 15 years ago, he was first diagnosed as having hemophilia A, and has been followed up in the department of Hematology. Computed tomogram (CT) revealed a well-marginated, uniform, marked wall thickening of the gallbladder with multiseptate enhancement. Magnetic resonance imaging (MRI) demonstrated diffuse wall thickening of the gallbladder by viewing high signal foci with signal void lesions. After factor VIII replacement, exploration was done. On operation, the gallbladder wall was thickened and the serosa were surrounded by dense fibrous adhesions which were often extensive and attached to the adjacent hepatic parenchyma. There was a small-sized abscess in the gallbladder wall near the cystic duct. Dissection between the gallbladder serosa and hepatic parenchyma was difficult. Cross sections through the wall revealed multiple yellow-colored, nodule-like lesions ranging from 0.5-2 cm. There were also multiple black pigmented gallstones ranging from 0.5-1 cm. The pathologic findings showed the collection of foamy histiocytes containing abundant lipid in the cytoplasm and admixed lymphoid cells. Histologically, it was confirmed as XGC. We report a case with XGC mimicking gallbladder cancer in a hemophilia patient.

Gastric juice ammonia vs CLO test for diagnosis of Helicobacter pylori infection.

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, P < 0.01). In ROC curve analysis, the gastric juice ammonia test showed higher true positive and lower false positive ratios than the CLO test (P < 0.05). 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.