Clinical Review of Primary Small Bowel Tumors

PURPOSE: The aims of this study were to identify the clinicopathological features and treatment outcome of primary small bowel tumors. METHODS: Sixty-five patients, with primary small bowel tumors, treated at the Samsung Medical Center, between November 1994 and February 2002, were retrospectively analyzed. The mean follow-up was 20.8 months, ranging from 2 to 93 months. RESULTS: The mean age of the patients was 55.5 years, ranging from 26 to 84 years, with 42 men and 23 women. The most common symptom was abdominal pain (58.5%), followed by bleeding and an abdominal mass. The mean duration of the symptoms was 4.6 months, ranging from 2 days to 24 months. Diagnostic studies were performed by an abdominal CT scan, small bowel series, enteroclysis and angiography. The primary sites of the tumors were the jejunum and the ileum in 33 and 32 patients, respectively. Thirteen (20.0%) patients had benign tumors, including 8 (12.3%) benign stromal tumors, 2 lipomas, 2 hamartomatous polyps and 1 cavernous hemangioma. Fifty-two (80.0%) of the patients had malignant tumors, including 26 (40.0%) malignant stromal tumors, 21 (32.3%) lymphomas and 5 (7.7%) adenocarcinomas. Surgery was performed on all patients; a resection and anastomosis in 45 (69.2%), a right hemicolectomy in 10 (15.3%), an ileocecectomy in 5 (7.6%) and a wedge resection in a further 5 (7.6%). Metastasis was found on initial presentation in 21 (40.4%) patients. Combined liver, bladder and colon resections were performed in 7 (10.7%) patients. Four (6.1%) patients died during the perioperative period. The overall 3 year survival rate of the patients with malignant small bowel tumors was 58.6%. CONCLUSION: Performing aggressive surgical manipulation in suspected small bowel tumors, and the use of postoperative adjuvant therapy in lymphomas, will result in better outcomes for patients.

Submucosal Gastric Actinomycosis in a Hematemesis Patient

We experienced a case of submucosal gastric actinomycosis, presenting as bleeding. The 65-year-old woman had a symptom of epigastric pain, without any other intra-abdominal disease entity. A gastrofiberscopic study demonstrated a submucosal mass lesion with bleeding at the fundus. Because of the bleeding, laparotomy was undertaken, and a abscess containing a large mass was found at the gastric fundus, and total gastrectomy undertaken. Histological examination revealed a giant acute ulcer with a submucosal abscess due to actinomycosis. Because of its rarity, submucosal gastric actinomycosis is an entity overlooked by most surgeons. We report upon this case of submucosal gastric actinomycosis and include a review of the literature.

Effect of Guanylate Cyclase Inhibition on the Concentration of Nitrite in Culture Medium of Vascular Smooth Muscle Cell

PURPOSE: Nitric oxide (NO) exerts the relaxant effect in vascular smooth muscle cells (VSMC) by activating soluble guanylate cyclase (sGC), which produces cyclic guanidine monophosphate (cGMP) in the cell. This study was undertaken to investigate the mechanism of the inhibitory actions of sGC inhibitors, LY 83583 and methylene blue in the VSMC. METHODS: VSMC was primarily cultured from rat aorta and confirmed by immunocytochemistry of anti-smooth muscle myosin antibody. Bacterial lipopolysacchride (LPS), an inducer of inducible nitric oxide synthase (iNOS) and sodium nitroprusside (SNP), an NO donor, were uesd to increase NO within VSMC. The changes in concentrations of nitrite in culture media by an addition of LPS or SNP with a pretreatment of LY 83583 or methylene blue were measured by the spectrophotometry with griess regent and absorbance at 550 nm. Western blot and RT-PCR for iNOS and iNOS mRNA, respectively were performed. RESULTS: LPS and SNP increased nitrite concentration. LY 83583 potentiated the increase in nitrite concentration by LPS and SNP. LY 83583 also increased expressions of iNOS protein and mRNA induced by LPS. Methylene blue has no effect on nitrite concentration increased by LPS or SNP, and it did not affect the expressions of iNOS protein or mRNA induced by LPS. CONCLUSION: These results suggest that the mechanism of inhibitory actions of LY83583 and methylene blue on sGC are different each other: LY83583 interferes the interaction of sGC and NO resulting positive feedback increase in iNOS gene expression, but methylene blue eliminates NO from cytosol inducing no compensatory effect.