ABSTRACT
Objective: To evaluate vascular endothelial growth factor (VEGF) levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and its relation to treatment response. Methods: A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically. Twenty patients were suitable to be treated by TACE, while other 20 patients were treated with PEI. Serum VEGF levels were measured before and 1 month after each procedure by ELISA. Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound. Results: There was no significant difference between TACE and PEI groups with regard to age, sex, tumor size, response to local therapy, or VEGF and alpha-fetoprotein before and after therapy. VEGF levels after TACE were significantly higher than before TACE [(298.1 ± 123.6) pg/mL vs. (205.8 ± 307.3) pg/mL; P = 0.001]. Also, VEGF levels were significantly higher after PEI than before PEI [(333.8 ± 365.6) pg/mL vs. (245.3 ± 301.8) pg/mL; P = 0.000]. Non-responders of both groups had significantly high VEGF levels than responder's, both before [(985.0 ± 113.2) pg/mL vs. (117.1 ± 75.3) pg/mL; P < 0.001] and after therapy [(1. 330.6 ± 495.7) pg/mL vs. (171.0 ± 94.7) pg/mL; P = 0.000)]. Conclusions: Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients. Higher levels of VEGF before and after therapy were found in non-responders, suggesting that VEGF is a useful marker in predicting treatment response.
ABSTRACT
Gastric antral vascular ectasia [GAVE] is a distinct vascular abnormality, mainly involving the gastric antrum. It is a rare but well-known cause of occult gastrointestinal bleeding. Various endoscopic treatment modalities have been tried in this condition. The aim of the study is to show the long-term effect of argon plasma coagulation [APC] on GAVE. Twenty-nine patients with endoscopically proved GAVE were enrolled in the study. Clinical assessment of GAVE patients, haemoglobin [Hb] level and transfused blood units were recorded after APC using 60-80-W power setting. A second session was done 1 month after the therapeutic procedure to ensure complete ablation of all lesions. The documented Hb levels and number of blood units transfused 3 months after APC were recorded. At endoscopy, all patients had the classic type of GAVE. The mean Hb level increased from 7.5 +/- 1.7 g dl[-1] before APC to 10.2 +/- 0.8 g dl[-1] after APC [p value <0.001]. The transfusion requirements significantly decreased to 0.2 +/- 0.5 units/patient [p value <0.001]. Endoscopic APC is a safe, effective and inexpensive modality in treating GAVE and could be an alternative to the currently available endoscopic methods
ABSTRACT
There is a frequent overlap between the clinical presentation of functional and organic bowel disorders. The aim of this study was to assess the role of faecal calprotectin in differentiating between both groups of patients in order avoid the use of invasive diagnostic procedures in patients with low probability of having functional disorders. We prospectively studied 39 patients presenting with lower gastrointestinal symptoms. On the basis of clinical and colonoscopic criteria 20 had functional and 19 had organic bowel disorder [10 had inflammatory bowel disease and 9 had organic non-inflammatory bowel diseases]. Ten healthy subjects were included as controls. Faecal calprotectin was measured in patients and controls by enzyme linked immunosorbent assay. Patients with inflammatory bowel disease had faecal calprotectin levels of 379.2 +/- 177.9 micro g/g [mean +/- SD]; this was higher than in patients with functional bowel disease [[27.97 +/- 15.2 micro g/g]; p: 0.004] and healthy controls [[21.64 +/- 11.3 micro g/g]; p: 0.0002]. Patients with organic non-inflammatory bowel disease had faecal calprotectin levels of 273.4 +/- 157.8 micro g/g, which is higher than in patients with functional bowel disorders [[27.97 +/- 15.2 micro g/g]; p: 0.002] and healthy controls [[21.64 +/- 11.3 micro g/g]; p: 0.0001]. There was no statistically significant difference between faecal calprotectin in patients with functional bowel disease and healthy controls [p: 0.264], and between both groups with organic bowel disease [p: 0.312]. Faecal calprotectin is a sensitive non-invasive method which can be used to identify patients with organic bowel disorders. It is not, however, able to differentiate between different types of organic bowel diseases