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Objective To assess the clinical characteristics of primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) and its treatment and prognosis. Methods Twenty patients diagnosed with PGI-DLBCL were admitted to hospital between 2003 and 2007. The clinical characteristics and tumor molecular model of PGI-DLBCL as well as therapeutic methods were retrospectively studied. The factors that related to survival and prognosis were statistically analysed.Results The overall survival (OS) time of the patients were from 42 months to 52 months,while the progression-free survival (PFS) time were from 37months to 47 months. The International Prognostic Index (IPI) score (0～2 or ＞2) played a reminding role in prognosis of the disease. Tumor molecular model was no effect on prognosis [that was no significant difference between germinal center B-cell-like (GCB) type and non-GCB type]. The efficacy of Rituximab in combination with CHOP chemotherapy (R-CHOP) in treatment of PGI-DLBCL was similar to CHOP chemotherapy alone, whereas surgical intervention might prolong survival period. Conclusions The biological characteristics of PGI-DLBCL is so particular that the most therapeutic method, which need to be further studied, would be different from DLBCL in other position.
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Objective To investigate the value of double-balloon endoscopy (DBE) and multi-slice CT enteroclysis (MSCTE) in diagnosis of Crohn's disease (CD) in small intestine. Methods DBE and MSCTE were performed in 71 patients with suspected Crohn's disease in small intestine. The two methods were compared in terms of diagnosis, extents of disease, existance of complications and activity of the disease according to the pathologic findings and the outcome of follow-up. Results The diagnostic yields of DBE and MSCTE were comparable with no significant difference (χ2=2.29, P> 0.05). The positive and negative likelihood ratios were 22.5 and 0. 022 in DBE respectively, and were 1.6 and 0. 240 in MSCTE respectively. The results of DBE was consistent with MSCTE in diagnosis of mild bowel stenosis, but was inconsistent with MSCTE in diagnosis of moderate-severe bowel stenosis (χ2=11.298, P=0.001). The concordance of two methods in diagnosis of disease activity was 95.8%. Conclusions The first choice in diagnosis of small bowel CD is DBE. The combination of two methods will be helpful in diagnosis and evaluation of CD severity.
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involved,reexamination with colonoscopy is reconanended.
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Objective To investigate the feasibility and clinical value of double-balloon endoscopy in subjects of failed conventional colonoseopy and gastro-intestinal tract modified surgery.Methods Doubleballoon endoscopy was performed in thirty-two subjects of failed conventional colonoscopy,three and nine patients of previous subtotal gastrectomy with BillrothⅡand gastro-intestinal modified surgery for various clinical manifestations.Suceessful intubation rates of terminal ileum or cecum in colonoscopic failure patients,afferent and efferent loop intubation in patients of BillrothⅡand alimentary tract modified surgery,were recorded and diagnostic yields in these patients were also observed.Results The endoscopy was successfully intubated into terminal ileum or cecum in 29 subjects,the intubated rate was 90.6%,the endoscopic diagnosis was obtained in 7 subjects,and endoscopic treatment was performed in 3 subjects.The endoscopy was successfully inserted in terminus of afferent loop and 150-180 cm of efferent below the anastomosis in all 3 patients of Billroth type Ⅱ gastrectomy,and the diagnosis was all clarified.And endoscopic retrograde cholangiopancreatography was performed in one patient.Five of nine patients with previous alimentary tract modified surgery had lesions detected after endoscopic procedure,and double-balloon endoscopy could have a thorough visualization on operated area and suspected region as needed.Abdominal pain and melaena were observed in 8 and 3 subjects respectively.Transient urine amylase elevation was found in one patient.The symptoms were alleviated and amylase was returned to normal after treatment.Conclusions Double-balloon endoscopy was a safe and feasible remediai endoscopic procedure with high diagnostic yields and endotherapeutic interventional capability,in patients of failed conventional colonoscopy and previous BillrothⅡgastrectomy and alimentary modified surgery.
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Objective To evaluate the diagnostic yield and accuracy of double balloon enteroscopy and capsule endoscopy in patients with obscure small bowel hemorrhage. Methods Twenty four patients with obscure small bowel hemorrhage were performed double balloon enteroscopy and wireless capsule endoscopy separately. The route of enteroscopy could be underwent either via mouth or via anus. Negative result of initial route was required afterwards for another via mouth or via anus examination. Capsule endoscope produced by GIVEN Imaging Company was used. The results of both methods were analyzed independently and final diagnosis of each case was compared thereafter. Results Totally 21 of 24 (87.5%) patients had positive findings with enterosocpy, while 11 of 24 (45.8%) patients had positive findings with capsule endoscopy. The etiological diagnosis of enteroscopy in all cases was confirmed by surgical exploration and pathological examination with the accuracy of 87.5% , however, the accuracy of capsule endoscopy was only 25% (6 cases). On assessment of procedure tolerance, double balloon enteroscopy under anaesthesia and capsule endoscopy were well tolerated than via mouth or anus route enteroscopy without anaesthesia. There was no severe procedure related complications. Conclusions The entire small intestine could be examined by double balloon enteroscopy with combination of mouth and anus route. Double balloon enteroscopy was superior to capsule endoscopy in etiological diagnosis of obscure small bowel bleeding. Capsule endoscopy had clinical diagnostic value in detection of multiple and long segment small bowel lesions. Double balloon enteroscopy could be served as the first option in diagnosis of obscure small bowel bleeding.
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Objective Survivin is overexpressed in gastric cancer. However it not expressed in normal gastric mucosa. The expression of survivin is tightly related to the prognosis of gastric cancer.By gene reconstruction we generated pcDNA3 survivin mutant(Cys84Ala) plasmid, and observed its effect on the gastric carcinoma cell lines. Methods The survivin mRNA and protein expression levels were determined by reverse transcription polymerase chain reaction(RT PCR) analysis,Western blot and immunohistochemical staining respectively . Flowcytometry and acridine orange staning were employed to detect apoptosis. Results Overexpression of survivin mRNA and protein were detected in the gastric cancer cell lines. Inhibition of survivin by survivin mutant cDNA induced apoptosis,activated caspase 3 activity,cleaved PARP and promoted cytochrome C releasing in gastric cancer cells,and effectively sensitized gastric cancer cells to chemotherapeutic agents. Conclusion Inhibition of survivin may induce apoptosis in gastic cancer and sensitize gastric cancer cells to chemotherapeutic agents.Survivin targeted therapeutic protocol may potentially benefit gastric cancer therapy.
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Objective To evaluate the diagnostic efficiency of double-balloon enteroscopy in small bowel Crohn’s disease. Methods In sixty five patients with suspected small bowel Crohn's disease double-balloon enteroscopy were performed, and some of them received enteroscopy and enteroclysis, capsule endoscopy as well.Results The first enteroscopy was performed via mouth in 20 of 65 cases, and the lesions were detected in 11 cases (55%), 5 of 9 cases(55.6%) had lesions detected in enteroscopy via anus while nothing was found in mouth route. Among 45 cases examed by enteroscopy firstly via anus, 34 cases had lesions detected (75.6%), 8 of 11 cases(72.7%) had lesions found in following exam via mouth. Totally 58of 65 had lesions detected through enterosocpy examination, the overall diagnostic yield was 89.2%. Twenty four of 46 cases had positive findings with enteroclysis. The diagnosis of Crohn's disease was comfirmed in 14 of 22 patients(63.6%) underwent capsule endoscoy. The diagnosis was finally confirmed by enteroscopy only in 11 patients(78.6%).Conclusion The entire small intestine could be examined by enteroscopy with combination of mouth and anus route. Double-balloon enteroscopy was an ideal diagnostic modality for small bowel Crohn's diseases, which was also valuable in assessment on extent and severity of the disease. Small bowel enteroclysis was a useful screening alternative for selecting procedure route in DBE.
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Objective To evaluate safety, extensity and clinical efficacy and patient tolerance of double-balloon push enteroscopy in diagnosis of patients with small bowel diseases. Methods Thirty cases suspected of small bowel diseases with negative findings of various routine diagnostic modalities were performed double-balloon push enteroscopy from April to July, 2003. Among which 20 cases were patients with gastrointestinal bleeding of unknown origin, and numbers of patient with abdominal pain, chronic diarrhea and partial small intestine obstruction of unknown causes were 5, 3 and 2 cases, respectively. Results The enteroscopy reached to jejunal-ileum transitional area, middle or low portion of ileum and terminal ileum in 9, 17 and 4 cases, with mean examination time ( 40.5 ?12.3) min , ( 64.3 ?18.6) min and ( 78.8 ?11.5) min , respectively. Most of patients were fairly tolerated to the procedure. The lesion was detected in 25 of 30 cases, the total diagnostic yield was 83.3% , and positive diagnostic rates in obscure gastrointestinal bleeding, abdominal pain, chronic diarrhea and partial small bowel obstruction were 80.0% , 80.0% , 33.3% and 100.0% respectively. No procedure-related complications were observed in all cases. Conclusion Double-balloon push enteroscopy was a safe, reliable diagnostic modality of high clinical value for small bowel diseases.
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Objective To evaluate the ability of virtual CT colonoscopy to detect colorectal proliferative lesions in endoscopically proven patients and its clinical application prospects. Methods Virtual colonoscopy was performed using thin section helical computed tomography of the abdomen and pelvis in 23 patients with conventional colonoscopic findings suggestive of abnormalities within 1 hour. The data from CT scanning was processed by computer with specific commercial software, two and three dimensional reconstruction was subsequently made. Results The diagnosis of colorectal carcinomas was made on virtual colonoscopy in 21 cases, among which 20 cases were endoscopically diagnosed as cancers and 1 case was found sigmoid stricture of unknown causes, that was finally confirmed surgically and pathologically. All polyps greater than 11 mm were identified both by conventional endoscopy and virtual colonoscopy. 19 polyps with size of 6～10 mm were detected on virtual colonoscopy, the location and size of 13 polyps were in accordance with those of endoscopic findings, 2 false positive polyps were reported in 6 newly detected polyps. Virtual colonoscopy correctly localized all 21 cancers, compared with 18 using conventional colonoscopy. Conclusion Virtual colonoscopy is a valuable clinical method in diagnosis of colorectal cancers and polyps with size larger than 6 mm, and it is a good indication for colonic stricture and colonoscopy intolerable patients.
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Objective To evaluate the diagnostic value of double-balloon push enteroscopy in patients with obscure small bowel bleeding. Methods Thirty-four cases with suspected small bowel bleeding were received double-balloon push enleroscopy from April to November 2003. Results The lesions were detected in 30 of 34 cases; the total diagnostic yield was 88. 3% . The enteroscopy reached to middle jejunum, middle or low portion of ileum in 1 and 3 cases with negative findings. Among thirty positive cases, the diagnosis were angiodysplasia 7 cases (20.6% , 1 in jejunum, 3 in jejunal-ileum, 3 in ileum) , small bowel tumor 11 cases (32.4% ) , all cases were certified by operation and pathology. The tumor growth in duodenum, jejunum and ileum were 2, 5 and 4 cases respectively. Pathology of incised tumors included lipoma, leiomyoma hemangioma, pheochromoeytoma, Kaposiform hemangioendothelioma and adenoearcinoma, 4 cases with Crohn's disease (11. 8% ) , and 8 cases in others. Conclusion The most common causes of obscure small bowel bleeding were angiodysplasia, small bowel tumor and Crohn's disease. Double-balloon push enleroscopy was a safe, reliable and effective diagnostic modality with high clinical value for obscure small bowel bleeding.