BACKGROUND/AIMS: Although the initial rate of hemostasis achieved by endoscopic treatment for acute non-variceal gastrointestinal bleeding (NVGIB) is high, recurrent or persistent bleeding occurs in 10% to 25% of the patients. The aim of this study was to assess the efficacy and safety of transcatheter arterial embolization (TAE) in patients with acute upper and lower NVGIB who could not be managed by endoscopic treatment. METHODS: A retrospective analysis of the clinical data was done in 43 patients (M/F: 26/17, mean age: 60 years) whom underwent angiography or TAE for acute upper and lower NVGIB between January 1998 and December 2003. Among 43 patients, 18 had upper NVGIB, 19 had lower NVGIB, and 6 had obscure gastrointestinal bleeding. Demographic characteristics and outcome parameters including the rates of hemostasis, in-hospital death, and complications were analyzed. RESULTS: Thirty-four patients underwent TAE while 9 patients underwent angiography. TAE was used as the first line treatment in 17 patients and as the second line treatment in others. Hemostasis was achieved in 29 of 34 patients (85.3%) by TAE. According to the site of bleeding, hemostasis was achieved in 14 of 17 patients (82.4%) with upper NVGIB and in 15 of 17 patients (88.2%) with lower NVGIB. There was no significant angiography or TAE-related complications such as bowel ischemia or infarction except a hematoma on the angiography site in one patient. CONCLUSIONS: TAE is effective and safe in patients with acute upper or lower NVGIB who cannot be managed by endoscopic treatment.
Adult ; Aged ; Aged, 80 and over ; Catheterization ; *Embolization, Therapeutic/methods ; English Abstract ; Female ; Gastrointestinal Hemorrhage/*therapy ; *Hemostatic Techniques ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: Ineffective esophageal motility (IEM) is a distinct manometric entity characterized by a hypocontractile esophagus. Recently, IEM replaced the nonspecific esophageal motility disorder (NEMD), and its associations with gastro-esophageal reflux disease (GERD) and respiratory symptoms are well known. We evaluated the relationship of IEM with GERD, and the diagnostic value of IEM for GERD. METHODS: We retrospectively analyzed recent 3-year (Jan. 1998-Sep. 2002) datas of esophageal manometry, acid perfusion test and simultaneous 24 hr-ambulatory pH-metry with manometry studies in 270 consecutive patients with esophageal and/or GERD symptoms. The prevalence of IEM in GERD group and non-GERD group, and the variables of pH-metry and manometry among esophageal motility disorders were compared. In addition, the sensitivity, specificity, positive predictive value, negative predictive value of IEM, esophageal symptom, and acid perfusion test for GERD were calculated. RESULTS: There was no significant difference in IEM prevalence rate between GERD group and non-GERD group. In addition, there was no significant difference in GERD prevalence rate and esophageal acid clearance in variety of motility disorder groups. Total percent time of pH <4 in IEM group did not show any difference when compared with other groups except in the achalasia group. In regard of diagnostic value to detect GERD, all positive results showed high specificity (97%) in IEM with esophageal symptom and positive acid perfusion test. CONCLUSIONS: The diagnosis of IEM using esophageal manometry in patients with various esophageal symptoms does not strongly suggest on association with GERD. However, IEM with concomitant esophageal symptoms and positive acid perfusion test has diagnostic values for GERD.
Adult ; English Abstract ; Esophageal Motility Disorders/*complications/diagnosis ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux/*complications/diagnosis ; Humans ; Male ; Manometry ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity

Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The reported incidence is 1-6%. The most common thromboembolic complications are deep venous thrombosis of legs and pulmonary thromboembolism. Cerebral thrombosis, portal vein thrombosis, retinal venous thrombosis and arterial thrombosis were also reported. We experienced a case of ulcerative colitis complicated with pulmonary thromboembolism. The patient was a 70-year-old woman who was diagnosed as ulcerative colitis on colonoscopy. We used prednisolone and sulfasalazine for the treatment of ulcerative colitis. Twenty five days later, she complained of abrupt dyspnea and chest pain. Chest CT and ventilation-perfusion scan revealed a thromboembolism in both lung. After the treatment of heparin & warfarin therapy, follow-up chest CT showed much regressed pulmonary thromboembolism. We report a 70-year-old woman with ulcerative colitis complicated with pulmonary thromboembolism and treated with heparin & warfarin therapy successfully.
Aged ; Colitis, Ulcerative/*complications ; English Abstract ; Female ; Humans ; Pulmonary Embolism/*complications

BACKGROUND/AIMS: As a preliminary study to test the possibility of oral transmission of hepatitis C virus (HCV), many investigations in order to detect the extrahepatic localization of HCV have been performed. In this study, we examined the presence of HCV viral proteins in gastric mucosa. METHODS: Immunohistochemical staining to NS3 protein were done to detect the HCV virus in gastric mucosa. The results were compared with NS5a protein staining to confirm the NS3 protein staining. RESULTS: Total of 164 patient were included. 58 patients with anti-HCV (+) were designated to case group and 70 with anti-HCV (-) to control group. 36 were excluded in this study due to concomittent illness. Anti-HCV (+) group showed 50.0% (29/58) of positivity to NS3 protein staining and anti-HCV (-) group showed 12.6% (9/70) of positivity (p<0.001). Immunohistochemical staining to NS5a protein were done to validate the result of NS3 (+) staining in the anti-HCV (+) group (n=58). NS5a (+) staining were observed in 58.6% (34/58). The results of NS5a staining were consistent with that of NS3 in 70.7%. The reliability coefficients by Chronbach's Alpha for NS3 and NS5a stain test was 0.59. CONCLUSIONS: HCV can exist in gastric mucosal cell as an extrahepatic presence. In the future, this study may provide some fundamental data for the research of possible oral transmission route of HCV.
Aged ; English Abstract ; Female ; Gastric Mucosa/*virology ; Hepacivirus/*isolation & purification ; Hepatitis C Antigens/*analysis ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: X-linked inhibitor of apoptosis (XIAP) is the most potent member of the IAP family that exerts antiapoptotic effects. Recently, XIAP-associated factor 1 (XAF1) and two mitochondrial proteins, Smac/DIABLO and HtrA2, have been identified to negatively regulate the caspase-inhibiting activity of XIAP. We explored the candidacy of XAF1, Smac/DIABLO and HtrA2 as a tumor suppressor in colonic carcinogenesis. METHODS: Expression and mutation status of the genes in 10 colorectal carcinoma cell lines and 40 primary tumors were examined by quantitative PCR analysis. RESULTS: XAF1 transcript was not expressed or present at extremely low levels in 60% (6/10) of cancer cell lines whereas Smac/DIABLO and HtrA2 are normally expressed in all cell lines examined. Tumor-specific loss or reduction of XAF1 was also found in 35% (14/40) of matched tissue sets obtained from the same patients. XAF1 transcript was reactivated in all the low expressor cell lines by treatment with the demethylating agent 5-aza-2'-deoxycytidine. Moreover, bisulfite DNA sequencing analysis for 34 CpG sites in the promoter region revealed a strong association between hypermethylation and gene silencing. Restoration of XAF1 expression resulted in enhanced apoptotic response to etoposide and 5-flurouracil, whereas knockdown of XAF1 expression by siRNA transfection significantly inhibited chemotherapeutic drug-induced apoptosis. CONCLUSIONS: XAF1 undergoes epigenetic gene silencing in a considerable proportion of human colon cancers by aberrant promoter hypermethylation, suggesting that XAF1 inactivation might be implicated in colonic tumorigenesis.
Cell Line, Tumor ; Colonic Neoplasms/*genetics ; *DNA Methylation ; English Abstract ; Gene Expression Regulation, Neoplastic ; *Gene Silencing ; Humans ; Intracellular Signaling Peptides and Proteins/genetics ; Mitochondrial Proteins/genetics ; Neoplasm Proteins/*genetics ; Promoter Regions (Genetics) ; Serine Endopeptidases/genetics

BACKGROUND/AIMS: The effects of curcumin on the growth of human colon cancer cell lines, HT-29 and WiDr cells were examined and the effects of 5-fluorouracil (5-FU) were also studied. METHODS: The growth of HT-29 and WiDr cells were examined by counting cell number on two and four days treatment with 1-40 micrometer of curcumin, and 0.1 microgram/mL, 0.3 microgram/mL of 5-FU. The reversibility of curcumin was examined on one day to seven days treatment with 10 micrometer curcumin after seeding to 2 10(4) cells/well. To examine the inhibitory effects of curcumin, cell cycle analysis was done on the HT-29 cells after four days treatment with 20 micrometer curcumin. RESULTS: Curcumin inhibited the growth of HT-29 and WiDr cells in a dose-dependent fashion. The growth rate of the group in which curcumin was removed by media change 24 hours after the treatment of curcumin was not different from that of control group. Curcumin combined with 5-FU markedly inhibited the growth of HT-29 and WiDr cells compared to curcumin or 5-FU alone. After four days treatment of HT-29 cells with 20 micrometer curcumin, the fraction of cells in G2-M phase was 35.3% in curcumin group, much higher than 13.8% of the control group. CONCLUSIONS: Curcumin significantly inhibited the growth of HT-29 and WiDr cells in a dose- dependent, reversible fashion.
Antineoplastic Agents/*pharmacology ; Cell Division/drug effects ; Cell Line, Tumor ; Colonic Neoplasms/*pathology ; Curcumin/*pharmacology ; English Abstract ; Flow Cytometry ; Fluorouracil/pharmacology ; HT29 Cells ; Humans

Hepatocellular carcinoma (HCC) is one of the most common malignancies world wide. Several experimental treatments have been tested against HCC. Those are chemotherapy, high dose proton beam radiotherapy, external beam radiotherapy, cyberknife, antibody-directed therapy and immunotherapy. Neither single nor combination therapy have demonstrated any clear reproducible benefit in terms of overall survival. Tamoxifen and antiandrogen therapy were not effective in prolonging survival when tested in randomized controlled trial. The modern radiation therapy concept such as intensity-modulated, image-guided, and stereotactic body radiation therapy may show promising effects on HCC. The increasing promise of targeted drug therapy in cancer needs to be particularly pursued in the treatment of HCC, in which cytotoxic agents are not usually effective. Other approaches include hormonal manipulation, immunotherapy, and specific inhibition of angiogenesis or growth factors. These issues stress the need for basic research in carcinogenesis in general and HCC in particular.
Carcinoma, Hepatocellular/*therapy ; English Abstract ; Humans ; Liver Neoplasms/*therapy

In spite of the nice screening program using the state-of-the-art imaging modalities, most patients with hepatocellular carcinoma (HCC) are not eligible for curative resection due to poor hepatic functional reserve and multiplicity of the tumors. Therefore they greatly rely on percutaneous interventional procedures. Among these, transcatheter arterial chemoembolization and local ablation therapies including ethanol injection therapy or radiofrequency (RF) thermal ablation have gained wider acceptance for the local treatment of unresectable HCC with growing evidence of survival gain. Although we need more prospective randomized trials to determine the definite role of these interventional therapies, the current consensus is that they are safe and effective for the local control of small HCC and have a potential to replace definitive surgical options. In this review, the basic principles and published clinical results including long-term survival rates and complications are reviewed. The benefits and limitations of each therapy are also discussed.
Carcinoma, Hepatocellular/radiography/*therapy ; Combined Modality Therapy ; English Abstract ; Humans ; Liver Neoplasms/radiography/*therapy ; *Radiography, Interventional

Due to recent rapid advances in imaging modalities, there has been a marked increase in the early diagnosis of hepatocellular carcinoma (HCC). Also, the emergence of effective local treatment methods has lead to the necessity for a wider selection of therapeutic modalities depending on the individual characteristics of each patient, such as tumor factors and hepatic factors, rather than a single uniform approach. At present, accurate preoperative liver function evaluation is available, and in addition, increased knowledge of the liver anatomy through liver transplantation, and advances in postoperative patient care has subsequently decreased the morbidity and mortality rates significantly after surgery. Such newly developed techniques and acquired knowledge has allowed the surgical option to expand from the classical hepatic lobectomy to systematic subsegmentectomy. Not only for early HCC, but also for intermediate HCC and advanced HCC, hepatectomy has shown the best results in each stage of disease with regard to treatment goals. It is therefore thought that hepatectomy should always be considered as the main treatment method in the multimodality treatment of HCC, as long as the liver function reserve permits, to enhance the quality of life, increase survival, and to cure disease. The authors present here a summary of the role of surgical approaches in HCC with respect to recent increases in the detection of early stage disease, new therapeutic modalities, and a new staging system for HCC.
Carcinoma, Hepatocellular/*surgery ; English Abstract ; Hepatectomy/methods ; Humans ; Liver Neoplasms/*surgery

In patients with chronic liver disease, hepatocelluar carcinomas are developed from regenerative nodule via dysplastic nodule and early hepatocellular carcinoma to advanced hepatocellular carcinoma during multistep hepatocarcinogenesis. In this article, imaging findings of various imaging modalities are described pertaining to the above mentioned hepatocellular nodules occurring in the cirrhotic liver, correlating with pathologic findings.
Carcinoma, Hepatocellular/*diagnosis ; Diagnostic Imaging ; English Abstract ; Humans ; Liver Neoplasms/*diagnosis