Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

BACKGROUND/AIMS: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. METHODS: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. RESULTS: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. CONCLUSIONS: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction.
Gastric Outlet Obstruction ; Humans ; Mucous Membrane ; Stents

Brunner's gland hamartoma is also called Brunner's gland adenoma and Brunner's gland hyperplasia of Brunneroma, and it is a rare tumor of the duodenum. This tumor is caused by a benign proliferation of Brunner's glands, and the disease is normally present on the duodenum. These tumors arise mainly in the duodenal bulb and only rarely in the jejunum and proximal ileum. The clinical manifestations are nonspecific gastrointestinal complaints such as bloating or epigastric pain, and the tumor often gives rise to melena or obstruction. We report here on a case of a giant Brunner's gland hamartoma in a 48 year-old woman, and it was treated by endoscopic polypectomy. We also include a review of the related literatures.
Adenoma ; Brunner Glands ; Duodenum ; Female ; Gastrointestinal Hemorrhage* ; Hamartoma* ; Humans ; Hyperplasia ; Ileum ; Jejunum ; Melena ; Middle Aged

The pancreas is a mixed exocrine and endocrine gland involved in the control of many homeostatic functions.During embryogenesis,the pancreas arises from dorsal and ventral evaginations of the foregut,which subse- quently fuse into a single organ.The characterization of early genes expressed in the developing pancreas is critical to understand its specification and differentiation.Pdx1 is one of the earliest markers of pancreatic development and a key molecule in its development.Sox proteins form a large class of transcriptional regulators implicated in the control of a variety of developmental processes.One member of this family,Sox9,is expressed in the developing pancreas, but little is known about the function of Sox9 in the developing pancreas.We further investigated Sox9 function during pancreatic development in Xenopus .Using a hormone-inducible inhibitory mutant of Sox9 ,we found that Pdx1 expres- sion was reduced in the ventral pancreatic buds in Sox9-depleted embryos.We suggest that Sox9 gene expression may be involved in pancreatic development in Xenopus.
Animals ; Endocrine Glands ; Gene Expression ; Hoof and Claw* ; Pancreas ; Xenopus

Lymphangioma is a benign tumor that is commonly found in children. Many lymphangiomas are congenital malfor- mations of the lymphatic system and they are considered to be lymphatic hamartomas. Lymphangiomas usually occur in the head, neck and axillary region, and they rarely occur in the gastrointestinal tract. Cystic lymphangioma is a rare cause of colonic submucosal masses. Lymphangioma of the colon has recently been diagnosed more frequently by performing colonoscopy and endoscopic ultrasonography. However, only a few cases of colonic intussusception due to lymphangioma have been reported in the literature. We experienced a case of intussusception that was caused by cystic lymphangioma of the colon, and we report here on the findings.
Child ; Colon* ; Colonoscopy ; Endosonography ; Gastrointestinal Tract ; Hamartoma ; Head ; Humans ; Intussusception* ; Lymphangioma ; Lymphangioma, Cystic* ; Lymphatic System ; Neck

Dieulafoy's lesion is a rare cause of massive gastrointestinal bleeding. It is usually identified within the proximal stomach but has been reported in the esophagus, duodenum, small intestine, colon and rectum. Surgery was originally the treatment of choice for this lesion. However, recently, most case can be treated using endoscopic techniques including an injection of a sclerosing agent, clipping, band ligation, heater probe, and bipolar coagulation. We report 2 cases of a rectal Dieulafoy's lesion that were treated sucessfully by endoscopic clipping without complications.
Colon ; Duodenum ; Esophagus ; Hemorrhage ; Intestine, Small ; Ligation ; Rectum ; Stomach

BACKGROUND/AIMS: Endoscopic or percutaneous internal drainage is a well-established palliative treatment for unresectable biliary tumors. Previous studies dealing with the unilateral versus bilateral liver lobe drainage have reported inconsistent results. This study evaluated the clinical efficacy of bilateral drainage with a newly designed T configured dual stent (T-stent) placement. METHODS: From 2001 to 2004, 46 hilar malignancies, which were not suitable for endoscopic retrograde biliary drainage (ERBD) on MR cholangiography were treated with the percutaneous placement of two self-expandable metallic endoprostheses in a T configuration through a single transhepatic access. The outcomes were examined retrospectively. The hilar malignancies, which were drain ed by unilateral ERBD were also reviewed. RESULTS: The 46 hilar malignancies drained by a T stent included a cholangiocarcinoma (n=36), gallbladder cancer (n=6), and metastatic cancer (n=4). Procedure related cholangitis occurred in 3 out of 46 patients (6.5%). The mean survival and stent patency times were 256 and 194 days, respectively. The 34 hilar malignancies drained by unilateral ERBD included cholangiocarcinoma (n=29), gallbladder cancer (n=3), and pancreatic cancer (n=2). Procedure related cholangitis occurred in 7 out of 34 patients (20.6%). The mean survival and stent patency times were 292 and 186 days, respectively. There were no statistically significant differences in the cholangitis frequency, survival and stent patency between the two groups. The frequency of cholangitis, mean survival and patency time in Klatskin tumors, which were drained by the T-stent (n=36) and ERBD (n=29), were compared. There were no significant differences in survival and stent patency time. CONCLUSIONS: T-configured dual stent placement can be used effectively in advanced biliary hilar malignancies. It can be used as a safe palliative drainage method in advanced hilar tumors, which are not suitable for ERBD.
Neoplasm Metastasis ; Pancreatic Neoplasms

Although cleft lip and palate are one of the most common craniofacial malformation, little is still known about the mechanism of the palate formation. Retinoic acid (RA) is known a teratogen, and cleft palate is induced by retinoic acid administration in the secondary palate formation stage. Many growth factors and their receptors are involved in the formation of the secondary palate. Here, we investigated the expression of PDGFR-alpha, and PDGFR-beta during palatogenesis after retinoid acid administration in mice by RT-PCR and immunohistochemistry. At E15.5, the opposing palatal shelves fused with one another in the control group, but the palatal shelves were not elevated and cleft palate was induced in the RA-treated group. In RT-PCR, PDGFR-beta was downregulated during palatogenesis after RA administration. In immunohistochemical experiment, PDGFR-alpha and PDGFR-beta were reduced in RA-induced group. Taken together, we suggest that PDGF receptors may be molecules involved in palate formation.
Animals ; Cleft Lip ; Cleft Palate ; Immunohistochemistry ; Intercellular Signaling Peptides and Proteins ; Mice ; Palate ; Receptors, Platelet-Derived Growth Factor* ; Tretinoin*

BACKGROUND: Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs and the presence of chest pain. The lesser success of pneumatic balloon dilation, also, has been reported for the subset with vigorous achalasia. Nevertheless, some authors have questioned the usefulness of making this distinction. We evaluated the difference of clinical manifestations and response to pneumatic balloon dilation between classic and vigorous achalaisia. METHODS: 28 cases involving patients with achalasia who underwent balloon dilation treatment were available for the review of their clinical findings, radiographic, manometric, esophageal scintigraphic parameters. Patients with vigorous achalasia [n=10] were defined by contraction amplitude >or=37 mmHg on esophageal manometry and patients with classic achalasia [n=18] as contraction amplitude <37 mmHg. RESULTS: Both groups of patients had substantial overlap in clinical findings, radiographic, manometric and esophageal scintigraphic parameters. The success rates of balloon dilation, also, were similar for both groups (classic vs vigorous, 78% vs 70%). CONCLUSION: It is concluded that the distiction of achalasia as classic and vigorous by an amplitude criterion is arbitrary and not useful.
Chest Pain ; Dilatation* ; Esophageal Achalasia* ; Humans ; Manometry

No abstract available.
Suicide, Attempted*