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Objective We examined the Grp78, ERK1/2 and phospho-ERK1/2 expressions in hepatocellular carcinoma(HCC) tissue samples in vitro, we interfered the expression of Grp78 in SMMC-7721 cells to explore whether Grp78 is involved in ERK1/2 signal pathway. Methods The Grp78, ERK1/2 and phospho-ERK1/2 expressions were detected by immunohistochemistry and confirmed by Western blotting in 47 HCC tissue samples. The Grp78 expression in SMMC-7721 cells was interfered by plasmid transfection and siRNA, ERK1/2 phosphorylation and expression were determined by Western blotting. Results The Grp78 expression was significantly correlated with ERK1/2 and phospho-ERK1/2 in HCC tissue samples. Overexpression of Grp78 promoted ERK1/2 phosphorylation in SMMC-7721 cells and the increased ERK1/2 phosphorylation was inhibited by Grp78 knockdown. Conclusion Grp78 is involved in the regulation of ERK1/2 signal pathway and might be a potential target for the comprehensive therapy of HCC.
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0.05).The incidence of adverse events was low and similar in each group. CONCLUSIONS Rifaximin is a safe and effective alternative to ciprofloxacin in the treatment of acute infectious diarrhea in adults.
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Objective To explore a method for development of carbon tetrachloride-induced cirrhotic model in rabbit and establish a portal vein delivery system in this model.Methods Male New Zealand white rabbit was subcutaneously injected carbon tetrachloride twice weekly,and the liver pathology and hepatic hydroxyproline content were examined after 12 weeks of injection.Portal vein catheterization was introduced through the terminal branch of mesostenium vein.The injection end of the catheter was embedded subcutaneously in the abdominal wall of the animal.The portal delivery was implemented by percutaneous puncture of the injection cap.Results After 12 weeks' of carbon tetrachloride administration,the rabbit liver developed typical pseudo lobule,and the liver hydroxyproline content increased 3.5 times compared to normal control.The portal vein delivery system could be maintained as long as 12 weeks.Conclusion A successive method to induce rabbit liver cirrhosis is developed,and a simple and economic animal portal vein delivery system is introduced.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic variceal sclerotherapy (EVS) for esophago gastric variceal bleeding.</p><p><b>METHODS</b>A retrospective analysis was made on 1010 patients with esophagogastric variceal bleeding who underwent sclerotherapy, among whom there were 834 patients with cirrhosis, 160 with hepatocarcinoma, 12 with Budd-Chiari syndrome and 4 with congenital liver fibrosis. Totally, 3203 sessions of sclerotherapy were performed, including 602 sessions of emergency sclerotherapy and 2601 of selective surgery. The average number of sessions of sclerotherapy for the initial treatment in 710 cirrhosis patients who received continuous sclerotherapy was 3.2 +/- 1.1 times. Follow-up was done in 579 cirrhosis patients for 3-157 months, with an average period of 42.5+/- 32.8 months.</p><p><b>RESULTS</b>The rate of emergency hemostasis in the whole group was 97.0%. The rate of complications was 13.4%, and the mortality rate was 1.8%. The rate of complete eradication and basically complete eradication of esophagogastric varices in cirrhosis patients was 84.1%. The late rebleeding rate was 23.7%, and the survival rates were 95.8% +/- 0.8%, 86.1% +/- 1.6%, 74.5% +/- 2.4%, 53.6% +/- 3.8% at 1, 3, 5 and 10 years, respectively, according to Kaplan-Meier analysis.</p><p><b>CONCLUSION</b>EVS is an important method for the treatment of esophagogastric variceal bleeding.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Esophageal and Gastric Varices , Therapeutics , Follow-Up Studies , Gastrointestinal Hemorrhage , Therapeutics , Retrospective Studies , SclerotherapyABSTRACT
Objective To assess the efficacy and safety of interventional techniques for the management of symptomatic portal vein (PV) and superior mesenteric vein (SMV) thrombosis. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic (TIPS) approach. Contrast PV SMV venography was carried out to verify the access to the PV branch. Then a 8F large bore catheter was used to aspirate thrombus. A J shaped guide wire and pig tail catheter were used to fragment the thrombus. Local thrombolysis with urokinase (UK) was delivered through a catheter in the SMV. An 4 French multiple side hole catheter was put into the SMV and UK was continuously infused for 3 to 13 days.Results The procedure was successful in all cases. One patient died of intra abdominal sepsis 12 days after. Five patients were followed up by color Doppler ultrasonography for 4～36 months with confirmed patency of the PV and SMV in all these patients. Conclusions This procedure is both safe and effective in the treatment of symptomatic PV and SMV thrombosis.
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To measure esophageal manometric parameters in liver cirrhosis, patients with different liver function grades were chosen. In the normal control group ( n =72) gastrointestinal disease history and symptoms, abdominal surgery and injury history were all negative. In liver cirrhosis group ( n =94) liver cirrhosis was diagnosed by clinical picture or pathology, and their liver function in Child grade was: grade A, 38 cases and 8 had ascites; grade B, 37 cases and 20 had ascites; grade C, 19 cases and 18 had ascites. Taking no motility medicines within seven days before measurement, esophageal motility parameters of these subjects were taken by a Biolab System made by Sandhill Company. The data were analyzed with SAS statistical software. The results showed that from Child grade A to C, LESP in cirrhosis group reduced, relaxation pressure increased, and relaxation percentage become lower successively; from Child grade A to C, onset peristaltic wave velocity in upper esophageal body became slower, peristaltic contraction reduced, and abnormal contraction increased; from Child grade A to C, peristaltic wave amplitude reduced in lower esophageal body, and velocity of onset peristaltic wave velocity became slower, peristaltic contraction reduced, and abnormal contraction increased. It suggests that more severe injury in liver function, more serious impact in esophageal motility. At the same time complications of portal vein hypertention such as esophageal varices and ascites behave synergetically.
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Crohn disease (CD) is a relatively infrequent disease in China. CD and intestinal tuberculosis (IT) are lack of specific clinical manifestations and are generally identified by endoscopic and histological examination. However, it is sometimes difficulty to distinguish them by endoscopy and histology. Their characteristics were investigated to offer more evidences and data for their differential diagnosis. The records of inpatients were reviewed from 1980～2001 in our hospital, all enrolled subjects were verified by endoscopy(or operation) and histology. The characteristics and key points of differential diagnosis of 28 CD cases and 14 IT cases were comparatively analyzed. The results showed that abdominal pain, mass, and hematochezia occurred more significantly in CD than in IT ﹙ P
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To evaluate the influences of sclerotherapy and band ligation on esophageal motility, EVS and EVL were measured before and after treatment respectively. After sclerotherapy, lower esophageal sphincter pressure (LESP)and residual pressure were decreased while relaxa tion was increased , relaxation duration became shorter; band ligation only influenced LESP.After EVS, the amplitude of motor waves in the sites of EVS and lower esophagus body was reduced ,and peristaltic wave duration was prolonged ,velocity of propagating contractions became faster , band ligation made the peristaltic wave duration in the sites of EVS and lower esophagus body become shorter, abnormal contractions increased. After EVS, antiacid medicine should be ased to reduced pH of gastric and raised LESP, and drugs to increase esophageal motility should be used after band ligation.
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0 05). No adverse reaction was seen in all patients. Our results suggest that intravenous Pantoloc is a good proton pump inhibitor in patients with duodenal ulcer combined with upper gastrointestinal bleeding, and it is similar to Losec in effectiveness and safety.
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Objective To analyze correlation of drug with acute drug-induced liver injury in 83 patients. Methods According to the international consensus criteria and Danan's causality assessment of a drug in the case of acute liver injury, 83 cases which had been clinically diagnosed as acute drug-induced liver injury were analyzed. Results Among the 590 inpatients of acute hepatitis, 83 (14.07%) were acute drug-induced liver injury, in whom 53 patients had liver cell damage (63.86%), 22 with cholestasis (26.5%), and 8 with mixed type (9.64%). In 34 patients, it was drug related (40.96%), undefined in 37 cases (44.57%), and unrelated in 12 cases (14.47%). Conclusion The international consensus criteria standardized the diagnosis of drug-induced liver injury and are helpful in differential diagnosis, but it needs improvement for actual implementation.
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Objective To investigate the rule of changes in endoscopic and endoscopic ultrsonic findings after endoscopic variceal sclerotherapy in the follow-up period. Methods Patients suffered from esophagogastric variceal bleeding and received endoscopic variceal sclerotherapy were investigated. Patients with liver cirrhosis after viral heptitis and their varices eliminated or reduced to grade Ⅰor Ⅱ after sclerotherapy entered this study for at least 5 years' follow - up. Endoscopic and endoscopic ultrsonic findings were recorded to find its course of transformation. Results Lumens of varices were occluded by thrombus and eventually replaced by white fibrous tissue after endoscopic sclerotherapy. Vessels reappeared within e-sophageal wall gradually after a lot of time in the form of formation of new venules (93. 8% ) or re-vascular-ization (6. 2% ) . Newly formed varices within gastric wall after sclerotherapy were seen in 5. 3% of the cases and some cases of duodenal varices were also found rarely in the follow-up. Endoscopic ultrasonic finding confirmed the revascularization and dilatation of vessles after sclerotherapy. Conclusion From the follow-up results it indicates that varices would reappear gradually after endoscopic sclerotherapy, regular re-examination and appropriate treatment in time are the most important measure to assure its long term effect.
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Objective To investigate the correlated factors concerning esophago-gastric variceal bleeding and sclerotherapy in liver cirrhosis. Methods Twenty-six factors were selected for 670 patients with liver cirrhosis and esophagogastric variceal bleeding and received sclerotherapy in our hospital. Spearman relationship analyses were performed on factors concerning esophagogastric variceal bleeding and sclerotherapy. Results Duration and number of episodes of bleeding were not related to grade of esophagogastric varices, diameter of portal vein and hepatic function but negatively related to ascites and hypersplenism.Severity of bleeding was not related to all of the above parameters. Esophageal varices related to gastric varices while neither of them related to diameter of portal vein. Result of sclerotherapy related to grade of esophageal varices, and negatively related to number of operations in first-period sclerotherpy, supplementary sclerotherpy and total number of operations as well as to amount of scleroant of first-period sclerotherpy and total amount of scleroant. Types of sclerosant had no relationship with result of sclerotherapy. Conclusion Esophagogastric variceal bleeding is affected by multiple factors. Diameter of portal vein is not the only factor. Result of sclerotherapy is affected by number of operations and amount of scleroant and has nothing to do with types of sclerosant.
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Objective To compare the diagnostic accuracy of intraductal ultrasonography(IDUS) and endoscopic retrograde cholangiography(ERC) on extrahepatic bile duct stones. Methods 30 patients with suspected extrahepatic bile duct stones by B Ultrasonography, CT,or MRI,were allocated into this study. ERC was performed first by the use of Fujinon duodenal endoscopy ( ED-410XT, ED-410XU) and then followed IDUS by inserting the Fujinon miniprobe (PL2220-15 or PL2226-15) through endoscopic working channel to detect extrahepatic bile duct, finally the substance in extrahepatic bile duct was proved by endoscopic sphincterotomy(EST)and stone extraction. Results Among 30 cases, the diagnoses by ERC were stone 26 cases,floccule 1 cases and misinterpreted 2 cases so the accuracy and sensitivity of ERC were 26/30(86.7%) and 26/28(92.9%)respectively. For IDUS, the diagnoses were totally in accordance with the results of EST and stone extraction.So the accuracy and sensitivity of IDUS in the diagnosis of extrahepatic bile duct stones were 30/30(100%) and 28/28(100%) respectively. Conclusion (1) IDUS was superior to ERC in the diagnosis extrahepatic bile duct stones. (2) IDUS can compensate the misinterpretation of ERC on extrahepatic bile duct stones.
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Objective To investigate the indication and therapeutic effect of endoscopic pancreatic stent insertion. Meth-ods 13 procedures of endoscopic sphincter incision,2 procedures of endoscopic pancreatic stone picking,3 procedures ofendoscopic papilla adenoma or carcinoma resection. 10 procedures of endoscopic stenosis dilatation and 20 procedures ofendoscopic pancreatic stent insertion were performed on 9 cases of chronic pancreatis (in which 3 cases had pancreaticstone), 1 case of acute recurrent pancreatis.4 cases of pancreatic cancer and 3 cases of papilla adenoma or carcinoma.The duration of stent preserve was 2 weeks to 8 months, average 3. 43 months. Results Remission of abdominal pain,improvement of appetite and digestive function was found in 16 cases. 12～35 months (average 26. 17 months) of follow-up was performed on patients of pancreatitis after the stents were removed. 7 cases had no recurrence of abdominal pain,3 patients still often had upper abdominal pain. Complications:3 cases had mild elevation of serum amylase and lipase. 1case had obstructive jaundice. Conclusion Endoscopc pancreatic stent insertion and drainage is suitable for pancreaticduct obstruction caused by chronic pancreatitis or cancer. It can alleviate symptoms and has reliable therapeutic effect andgood security.
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Objective Apaf-1 is a key factor involved in activating the Caspase system in apoptosis. The aim of this study was to evaluate the significance of Apaf-1 on the apoptosis process induced by chemotherapeutic agent. Methods We established Apaf-1 hyper- and hypo- expression system by transferred sense and anti-sense Apaf-1 cDNA into cultured AGS cell line. And meanwhile human cyt-c, Apaf-1, caspase-3, bax, and bcl-2 gene expressions were measured by RT-PCR method. Results Cyt-c, caspase-3, and bax gene expressions increased significantly after sense Apaf-1 transfection. On the contrary, anti-sense Apaf-1 transfer has minus effects on cyt-c, caspase-3, and bax gene expressions. No significant changes have been found on bcl-2 gene expression after transfection process.Conclusions Cyt-c pathway may play an important role in the apoptosis induced by chemotherapeutic drugs. The early expression of cyt-c and Apaf-1 may be the key procedure of cyt-c release from mitochondria and of caspases activation.
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Objective To evaluate the efficacy of scle rotherapy (EVS) for esophageal variceal bleeding. Methods Retrospective analysis was made in 1 010 patients with es ophageal variceal bleeding who underwent sclerotherapy, among them 850 patie nts were cirrhosis and 160 patients were hepatocellular carcinoma. The total num ber of procedures of sclerotherapy were 3 203, including 602 for emergency scler otherapy and 2 601 for selective sclerotherapy. Supplementary sclerotherapy was performed in 502 cases. Average procedures of sclerotherapy for initial treatme nt were 3.18?1.1 in 710 cirrhotic patients. Follow-up was made in 579 cirrhosi s patients for 3-157 months, with an average follow-up period of (42.47?32.78) months. Results 1. The hemostasis rate in the whole group was 97.0%, the c omplication rate was 13.4%, and the mortality was 1.8%. 2. Rate of complete and nearly complete elimination of esophageal varices in cirrhotic patients was 84 .1 %, and long term rebleeding rate was 23.7%. Survival rates were (95.8?0.8)% 、(86.1?1.6)%、(74.5?2.4)%、(53.6?3.8)% at 1,3,5 and 10 year according to t he Kaplan-Meier analysis. Conclusions EVS is an important method of treatment for esophageal variceal bleeding.
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Objective To investigate the role of endoscopic color Doppler ultrasonography (ECDUS) in the preoperative localization of insulinomas. Methods Seven patientsd woman) with biochemically diagnosed insulinoma underwent abdominal US, spiral CT and ECDUS in an attempt to precisely localize the tumor before surgery. Surgical and pathological results were considered as the definite localization of tumor. The role of ECDUS in the preoperative localization of insulinomas was compared with that of abdominal US and spiral CT. Results Ten tumors were detected by surgery and pathology. The sensitivity of ECDUS in identifying insulinomas was 8/10 compared with 1/10 for CT and 0/10 for abdominal US. Two tumors not detected by ECDUS had a size below 0. 5cm. Conclusions ECDUS is superior to spiral CT or abdominal US, and should be served as the first choice in the detection of pancreatic isulinomas. ECDUS identification depends on the size of the tumor and 'is hard to detect the tumors smaller than 0. 5cm.
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Biopsies were randomly taken from 160 patients through endoscopy. Among them 46 patients suffered from chronic superfacial gastritis, 39 patients from chronic atrophic gastritis, 39 patients from gastric ulcer, and 36 patients from gastric cancer. Ras, p16, and p53 genes were analysed with polymerase chain reaction single strand conformation polymorphism (PCR SSCP). Helicobacter pylori (HP) was examined with RUT. Result: ① the positive rates of ras and mutant p53 in gastric cancer were significantly higher than that in gastritis and gastric ulcer( P
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Twenty four hour esophageal pH monitoring was performed in 79 ambulatary patients suffering from reflux symptoms, in whom 40 with esophagitis and 39 without. The aim of the study was to investigate the correlation between reflux symptoms and objective occurrence of acid reflux in the patients with and without esophagitis. The results showed that the six parameters of Johnson/DeMeester score were significantly higher for esophagitis than endoscopic negative patients. The composite score were (85.85?15 10) and (26 20?9 25), respectively( P
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Objective To investigate the incidence of hepatocellular carcinoma (HCC) among patients with esophageal varices bleeding previously treated with endoscopic sclerotherapy, and to evaluate the factors influencing prognosis of HCC patients.Methods The clinical data of patients (from April 1987 to May 2003) who had received sclerotherapy for esophageal varices bleeding, and also that of HCC patients who had had sclerotherapy for esophageal varices bleeding were retrospectively reviewed. The survival rates of HCC patients were evaluated with Wilcoxon-Gehan method. Sixteen risk factors for HCC were assessed by multivariate analysis (Cox model). Results A total of 934 cases were treated with sclerotherapy, among which 109 patients suffered from HCC while 825 patients did not. In 22 HCC patients with esophageal varices bleeding sclerotherapy was not given. 31 out of 825 patients (3.76%) developed HCC during the follow-up period. 17 out of 31 patients received regular follow-up while 14 cases did not. The median surviving time of 31 patients was 13 months. The survival rate of patients with HCC under regular follow-up was significantly higher than that of patients under irregular follow-up(P=0.0002); risk factors, i.e. Child-Pugh classification, age and regular or irregular follow-up, were significantly related to the prognosis of patients with HCC(P=0.039、0.029 and 0.021, respectively). Conclusion Surveillance of patients with decompensated liver cirrhosis may increase the diagnostic rate of small HCC and prolong life expectancy; sclerotherapy can lower the incidence of HCC and it may play an active role in decreasing the incidence of HCC.