PURPOSE: Tumor bleeding is a major complication in inoperable gastric cancer. The study aim was to investigate the effects of proton pump inhibitor (PPI) treatment for the prevention of gastric tumor bleeding. MATERIALS AND METHODS: This study was a prospective double-blind, randomized, placebo-controlled trial. Patients with inoperable gastric cancer were randomly assigned to receive oral lansoprazole (30 mg) or placebo daily. The primary endpoint was the occurrence of tumor bleeding, and the secondary endpoints were transfusion requirement and overall survival (OS). RESULTS: This study initially planned to enroll 394 patients, but prematurely ended due to low recruitment rate. Overall, 127 patients were included in the analyses: 64 in the lansoprazole group and 63 in the placebo group. During the median follow-up of 6.4 months, tumor bleeding rates were 7.8% and 9.5%, in the lansoprazole and placebo groups, respectively, with the cumulative bleeding incidence not statistically different between the groups (P=0.515, Gray's test). However, during the initial 4 months, 4 placebo-treated patients developed tumor bleeding, whereas there were no bleeding events in the lansoprazole-treated patients (P=0.041, Gray's test). There was no difference in the proportion of patients who required transfusion between the groups. The OS between the lansoprazole (11.7 months) and the placebo (11.0 months) groups was not statistically different (P=0.610). Study drug-related serious adverse event or bleeding-related death did not occur. CONCLUSIONS: Treating patients with inoperable gastric cancer with lansoprazole did not significantly reduce the incidence of tumor bleeding. However, further studies are needed to evaluate whether lansoprazole can prevent tumor bleeding during earlier phases of chemotherapy (ClinicalTrial.gov, identifier No. NCT02150447).
Drug Therapy ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Lansoprazole ; Primary Prevention ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Stomach Neoplasms*

BACKGROUND: The extracellular matrix (ECM) produced by dermal fibroblasts supports skin structure, and degradation and/or reduced production of ECM are the main causes of wrinkle formation. OBJECTIVE: The aim of this study was to identify the active ingredient that enhances ECM production in dermal fibroblasts. METHODS: Polarity-based fractionation was used to isolate the active ingredient from natural extracts, and the effects of cedrol (isolated from Pterocarpus indicusirginia) on ECM production in cultured human dermal fibroblasts was investigated by reverse transcription-polymerase chain reaction, enzyme linked immunosorbent assay, and Western blot analysis. RESULTS: Cedrol accelerated fibroblast growth in a dose-dependent manner and increased the production of type 1 collagen and elastin. Phosphorylation of p42/44 extracellular signal-regulated kinase, p38 mitogen-activated protein kinase, and Akt was markedly increased by cedrol, indicating that enhanced ECM production is linked to activation of intracellular signaling cascades. CONCLUSION: These results indicate that cedrol stimulates ECM production, with possible applications to the maintenance of skin texture.
Blotting, Western ; Collagen ; Collagen Type I ; Elastin ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fibroblasts ; Humans ; Phosphorylation ; Phosphotransferases ; Protein Kinases ; Pterocarpus ; Skin ; Terpenes

PURPOSE: The aim of the present study was to assess the association between the pre-operative plasma fibrinogen level and the adjacent organ involvement in advanced gastric cancer. MATERIALS AND METHODS: A total of 923 pre-operative plasma samples were obtained from 923 patients diagnosed clinically as having advanced gastric cancer, and fibrinogen levels were measured by immunoassay. Associations between fibrinogen levels and clinicopathologic findings (depth of tumor, adjacent organ involvement, and lymph node metastasis), along with survival were examined by univariate and multivariate analyses. RESULTS: Tumor size, tumor depth, and the presence of lymph node metastasis were found to be positively correlated with the preoperative plasma fibrinogen levels (P<0.001). Fifty (5.4%) patients had adjacent organ involvement. Lymphatic invasion (P<0.001), tumor size (P<0.001), clinical T (depth of invasion) stage (P<0.001), and clinical nodal stage (P=0.018) were found to be associated with adjacent organ involvement. Univariate and multivariate regression analyses showed that a preoperatively elevated plasma fibrinogen level was associated with adjacent organ involvement (P<0.001, 0.028), and Kaplan-Meier analysis showed that it was associated with poorer survival (P<0.001). CONCLUSIONS: Plasma fibrinogen was found to be a clinically useful marker of adjacent organ involvement and overall survival. When a high fibrinogen level is encountered, preoperatively, adjacent organ involvement should be suspected in clinically advanced gastric cancer.
Fibrinogen ; Gastrectomy ; Humans ; Immunoassay ; Kaplan-Meier Estimate ; Lymph Nodes ; Neoplasm Metastasis ; Plasma ; Stomach Neoplasms

Renal thromboembolism almost always occurs in the setting of cardiac disease. Acute renal infarction may occur rarely in middle-aged patients without apparent risk factors for cardiac thromboembolism. We report a 40-year-old man who developed bilateral renal infarction and had no cardiovascular risk factors, except smoking. In middle-aged healthy patients with renal colic without lithiasis, the diagnosis of idiopathic renal infarction should be considered, especially if lactate dehydrogenase is elevated.
Adult ; Heart Diseases ; Humans ; Infarction ; Kidney ; L-Lactate Dehydrogenase ; Lithiasis ; Renal Colic ; Risk Factors ; Smoke ; Smoking ; Thromboembolism

BACKGROUND/AIMS: To evaluate the association between Helicobacter pylori (H. pylori) infection and gastric cancer (GC) according to tumor subtype in Korea. METHODS: H. pylori status was determined serologically using the enzyme-linked immunosorbent assay. In total, 2,819 patients with GC and 562 healthy controls were studied. A logistic regression method was used after adjusting for possible confounders. RESULTS: The prevalence of H. pylori infection was significantly higher in the GC patients (84.7%) than in the controls (66.7%) (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.46-3.97). The adjusted OR was significantly higher in H. pylori-infected patients aged <60 years (OR, 4.69; 95% CI, 3.44-6.38) than in those aged > or =60 years (OR, 1.48; 95% CI, 0.88-2.46; p<0.001). Subgroup analyses revealed no differences in seroprevalence between early gastric cancer (84.8%; OR, 3.01; 95% CI, 2.27-4.01) and advanced gastric cancer (84.6%; OR, 2.94; 95% CI, 2.24-3.85), cardia cancer (83.8%; OR, 2.98; 95% CI, 2.16-4.02) and noncardia cancer (84.8%; OR, 3.17; 95% CI, 2.48-4.04), and differentiated carcinoma (82.7%; OR, 2.99; 95% CI, 2.21-4.04) and undifferentiated carcinoma (86.8%; OR, 3.05; 95% CI, 2.32-4.00). CONCLUSIONS: The seroprevalence of H. pylori was higher in GC patients than in healthy controls, especially in younger patients. H. pylori infection is associated with GC, regardless of the tumor location, stage, or differentiation.
Aged ; Carcinoma ; Cardia ; Enzyme-Linked Immunosorbent Assay ; Helicobacter ; Helicobacter pylori ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Prevalence ; Seroepidemiologic Studies ; Stomach Neoplasms

Chios gum mastic (CGM) is obtained from the stem and leaves of Pistacia lentiscus trees and has been extensively used for centuries in Mediterranean and Middle Eastern countries, both as a dietary supplement and herbal remedy. This study was undertaken to examine in vitro effects of cytotoxicity and growth inhibition, and the molecular mechanism underlying modulation of cell cycle and induction of apoptosis in YD9 human oral squamous carcinoma cell line treated with CGM. The viability of YD9 cells and human normal keratinocyes (HaCaT cells), and the growth inhibition of YD9 cells were assessed by the MTT assay and clonogenic assay respectively. The hoechst staining and DNA electrophoresis were conducted to observe the YD9 cells undergoing apoptosis. YD9 cells were treated with CGM, and Western blotting, immunocytochemistry, confocal microscopy and FACScan flow cytometry were conducted. Mitochondrial membrane potential change and proteasome activity were measured. CGM treatment on YD9 cells resulted in a does-dependent inhibition of cell growth and induced apoptotic cell death. And tested YD9 cells showed several lines of apoptotic manifestation. Flow cytometric analysis revealed that CGM resulted in G1 arrest in cell cycle progression which was associated with decrease in the protein expression of cyclin D1, cyclin D3, Cdk2 and Cdk4, and increase in the protein expression of p21(WAF1/CIP1) and p53. These results demonstrate that CGM induces G1 the cell cycle arrest via the modulation of cell cycle-related proteins, and apoptosis via mitochondria and caspase pathway in YD9 cells, suggesting that CGM can be considered as a novel therapeutic strategy for human oral squamous cell carcinoma from its strong cell cycle arrest and apoptosis-inducing activity.
Apoptosis ; Blotting, Western ; Carcinoma, Squamous Cell ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Death ; Cell Line ; Cyclin D1 ; Cyclin D3 ; Dietary Supplements ; DNA ; Electrophoresis ; Flow Cytometry ; Gingiva ; Humans ; Immunohistochemistry ; Membrane Potential, Mitochondrial ; Microscopy, Confocal ; Mitochondria ; Pistacia ; Proteasome Endopeptidase Complex ; Proteins ; Resins, Plant ; Trees

PURPOSE: The prognosis for patients with liver metastases (LM) from colorectal cancer is significantly influenced by the clinician's decision. Recently, there have been remarkable advances in treatment of LM, so there can be some changes in therapeutic modalities. We performed a comparative study between operated and non-operated groups of patients with LM to analyze the clinical outcome. METHODS: From Feb. 2001 to Feb. 2006, 27 patients with LM underwent a hepatectomy, and 113 patients received non-surgical therapy. thirteen hepatectomized cases among the 27 patients had multiple LM. The outcomes of those 13 patients (Group A) were retrospectively compared to those of the non-operated group (Group B, n=21), which had had potentially resectable LM at the initial diagnosis or after chemotherapy, but didn't undergo hepatic resection. RESULTS: After a median follow-up duration of 31.3 months, the estimated 3-years overall survival (OS) rates were 76.9% and 14.3% in group A and B, respectively (P=0.0001). In the stepwise Cox multivariate regression analysis, factors such as the absence of hepatic resection and a greater diameter of the liver mass independently influenced the poor survival (P=0.005 and P=0.012 respectively). Additionally, two radiologists evaluated the intraoperative ultrasonographic (IOUS) results. IOUS detected new metastatic lesions in 4/13 (30%) patients. There were sub-centimeter metastatic lesions (5~7 mm) and had not been detected in SPIO-enhanced MRI. CONCLUSIONS: Our results compared to palliative chemotherapy suggest that aggressive surgical resection should be performed to increase the survival rate in patients with LM. Additionally, the treatment plan for LM patients should be discussed with the gastroenterololgist, the radiologist, the oncologist, and the surgeon.
Colorectal Neoplasms* ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Survival Rate

BACKGROUND: Metastatic skin cancer may have profound diagnostic, therapeutic, and prognostic significance. OBJECTIVE: We studied patients with metastatic skin cancer to determine the relative frequencies of metastatic skin cancer according to the type and location of the primary tumor and the site of the cutaneous metastasis. METHODS: We reviewed medical records and histologic materials of 68 patients with metastatic skin cancer in Catholic University Hospital from January 1991 to March 2001. RESULTS AND CONCLUSIONS:Of 61,218 patients with internal malignancy, 68(0.11%) had metastatic skin cancer. The mean age at diagnosis was 64.7 in male and 58.2 in female. Male to female ratio was 1:2.2. Breast carcinoma was by far the most common primary neoplasm resulting in skin involvement and accounted for 31(45.6%) of total cases and 63.8% of the cases in women. The most common clinical presentation is a nodule(26.5%) or multiple nodules(64.7%) although carcinoma erysipelatoides(4.4%) and carcinoma en cuirasse(4.4%) were also seen. Histopathologic examination most frequently revealed adenocarcinoma(70.6%) that was sometimes suggestive of the site of origin.
Breast Neoplasms ; Diagnosis ; Female ; Humans ; Male ; Medical Records ; Neoplasm Metastasis ; Skin ; Skin Neoplasms*

OBJECTIVES: For many years, inflammatory bowel disease has been thought to have a strong psychosomatic component, but recent prospective studies show no evidence of correlation between various psychologic factors and the disease activity. However, chronic renal disease still places unique stresses on the hemodialysis patients, with consequent emotional reactions. The aims of this study are to investigate the psychologic factors of ulcerative colitis and hemodialysis patients using MMPI scales, which are objective psychological test, thus give aid to psychological understanding of these patients. MOTHODS: We investigated 23 ulcerative colitis patients in remission followed at outpatient department of Hanyang University Hospital and 25 patients receiving hemodialysis between June, 1994 and August, 1995. Twenty students were selected for normal control group. We utilized T-score of each MMPI scale for analyzing characteristics of each group and regard T-score over 70 or below 40 as abnormal. RESULTS: The average T-scores of each MMPI scale in ulcerative colitis, hemodialysis patients & normal control group were within normal range between 40 and 70, except for T-score of Es scale in hemodialysis patient group(34.5). The results of comparison between each MMPI scale of two patients & normal control group were as follows. 1) L scale was significantly elevated in ulcerative colitis & hemodialysis patients group compared with that of normal control group. F scale was significantly elevated in hemodialysis patients compared with that of ulcerative colitis patients & normal control group (p<0.01). 2) Hs(p<0.01), D, Pt(p<0.05) and Sc(p<0.01) scales were significantly elevated in hemodialysis patients compared with those of ulcerative colitis patients & normal control group. 3) Es scale was significantly lower in hemodialysis patients compared with that of ulcerative colitis patients & normal control group(p<0.01). CONCLUSION: The result presented in this study reflects emotional disturbances, functional impairment, stressful life condition, excessive hypochondriacal thinking, depressed mood and egocentric tendency of hemodialysis patients compared with ulcerative colitis patients & normal control group. This result also reflects the projective tendency, hostility, difficulty in rapport formation, psychologic disturbance, obssesive and rigid personality, anxiety and retiredness of hemodialysis patients compared with ulcerative colitis patients & normal control group. On the other hand, we can't find any statistically significant differences between ulcerative colitis and normal control group.
Affective Symptoms ; Anxiety ; Colitis, Ulcerative* ; Hand ; Hostility ; Humans ; Inflammatory Bowel Diseases ; MMPI* ; Outpatients ; Psychological Tests ; Reference Values ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Thinking ; Ulcer* ; Weights and Measures

OBJECTIVE: Acute Renal Failure is a clinical syndrome characterized by a sudden decrease in renal function which was previously normal. Despite advances in medical care, prognosis in ARF is variable according to the influence of demographic factors, severity of ARF, nature of disease causing ARF, coexisting disease, treatments applied, and complications. We studied the recent changes of clinical feature of ARF. METHODS: We studied retrospectively 245 patients with ARF who had been hospitalized at Kyung Hee University Hospital between February 1988 and March 1993. RESULTS: 1) Male to female sex ratio was 1.8 : 1, and the incidence was high in above fifth decade (67.8%). 2) Acute renal failure was classified, according to clinical background, into medical group 79.6% (195 cases) and surgical group 20.4% (50 cases), and oliguric group 40.8% (100 cases) and non-oliguric group 59.2% (145 cases). 3) Acute renal failure due to medical causes included ARF by hemorrhagic fever with renal syndrome (25.6%), drugs and chemicals (17.9%), sepsis (17.4%) and systemic infection (7.7%) etc. ARF due to surgical causes included ARF by multiple trauma (34%), various surgical procedures (30%), surgical sepsis (14%), burn (12%) etc. 4) During admission, the expired patients had more severe biochemical and clinical characteristics including high BUN and serum potassium (p<0.01), lower serum albumin (p<0,01) than those of survivor. 5) Infections as the cause of ARF were 107 cases (43.7%), which included hemorrhagic fever with renal syndrome 50 cases, sepsis 31 cases, urinary tract infection 7 cases and respiratory tract infection 6 cases etc. The most common infecting organism was Hantavizus (50.5%). There was a greater number of gram-negative organisms than gram-positive organisms (34.1% vs 9.9%). 6) The overall mortality rate in patients with ARF was 31.4Fo. The presumptive causes of death were underlying disease (59.7%) such as sepsis, acute poisoning, cardiogenic and hypovolemic shock, and respiratory failure (14.3%), hyperkalemia (9.1%), pulmonary edeme (6.5%), and metabolic aidosis (2.6%) in order of frequency. 7) The highest mortality rate was 42.6% in patients above 50 years old. Mortality rate in patients with ARF due to surgical causes (52.0%) was significantly high than that of medical causes (26.2%) (p<0.05). Among the expired patients, oliguric group was 72.7%. In conclusion, there have been major trends in the clinical features of acute renal failure in this study. Especially, significant increase in the number of elderly patients, non-oliguric patients, and medical causes such as hemarrhagic fever with renal syndrome or sepsis were observed. Survival rate significantly decreased with increasing age, in acute renal failure by surgical causes, in oligurie patients, and in the presence of complicating factors such as sepsis or shock.
Acute Kidney Injury* ; Aged ; Burns ; Cause of Death ; Demography ; Female ; Fever ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Hyperkalemia ; Incidence ; Male ; Middle Aged ; Mortality ; Multiple Trauma ; Poisoning ; Potassium ; Prognosis ; Respiratory Insufficiency ; Respiratory Tract Infections ; Retrospective Studies ; Sepsis ; Serum Albumin ; Sex Ratio ; Shock ; Survival Rate ; Survivors ; Urinary Tract Infections