Usefulness of actim Pancreatitis(R) Test for Screening of Acute Pancreatitis in The ED

BACKGROUND: Acute pancreatitis is a fairly common abdominal disorder that can be easily confronted in the emergency department(ED) and is one of the most complex and clinically challenging of all abdominal disorders. Currently, there is no gold standard for the diagnosis of acute pancreatitis. We evaluated the usefulness of the actim Pancreatitis(R) rapid test, which has been recently developed in Europe, as a screening test of acute pancreatitis in our emergency department. METHODS: We prospectively studied the urinary trypsinogen-2 dipstick tests(actim Pancreatitis(R), Medix Biochemica, Kauniainen, Finland) of 200 patients with acute abdominal pain who were treated at our ED. All urine samples were collected from the patients within 12 hours of arrival at ED. We also measured serum amylase assay in the laboratory and compared the sensitivities and the specificities of the two test. Acute pancreatitis was diagnosed by authors according to standardized criteria. Abdominal USG or CT was performed when a patient with a normal serum amylase level had a typical clinical presentation. RESULTS: The actim Pancreatitis(R) rapid test was positive in 22 of the 25 patients with acute pancreatitis(sensitivity, 88.0 percent). The test was also positive in 6 of 175 patients without pancreatitis(specificity, 96.6 percent). The serum amylase assay had a sensitivity of 68.0 percent(with a cutoff value of 300 U per liter for the upper reference limit) and a specificity of 90.9 percent. But there were no statistical differences between the correlation coefficients of the two tests as diagnostic tool CONCLUSION: In patients with acute abdominal pain who are seen in the emergency department, the actim Pancreatitis(R) urinary dipstick test has a high degree of probability as a screening test for acute pancreatitis. Also it can easily and rapidly be use at the bedside.

Clinical Analysis of Pediatric Death in Emergency Room

PURPOSE: Sudden, unexpected pediatric death triggers acute grief in most survivors. In this study, we analyzed the pediatric death in emergency room in order to find out the factors for minimized unexpected pediatric death and increase awareness of these conditions. METHODS: We performed a review on the records of 63 patients under the age of 16 years who died before and after admission to the emergency room of Yeungnam University Hospital during a 5 year period from January 1996 to December 2000. RESULTS: Among the total of 63 patients who died, 33 were male(52.4%) and 30 were female (47.6%). The most prevalent age group was between 1 month and 1 year of age(38%). We classified 3 categories by the direct cause of death, disease 21 cases(33%), accident 19 cases(30%), unknown 23 cases(37%) respectively. Among 23 cases of unknown cause of death, 13 cases(56.5 %) had been placed under medical attention for underlying diseases : these were 7 cases of neurologic disorder(30.4%) 5 cases of congenital heart disease 5 cases(21.7%) and 1 case of metabolic disease(4.4%). The most common types of accident were traffic accident(10 cases; 52.6%) and the next were drowning(4 cases; 21%), asphyxia(3 cases; 15.8%). CONCLUSION: In unexpected pediatric death, among unknown causes of death, the number of patients who had an underlying disease was greater than these patients who did not. We conclude, more attention needs to be paid to underlying disease, especially congenital heart disease and neurologic disease. A parents teaching program is necessary emergency for situations. This would decrease cases of unexpected pediatric death.

Vascular Endothelial Growth Factor (VEGF) Expression and Angiogenesis in Gastric Cancer

PURPOSE: This study was designed to evaluate the angiogenic activities of gastric cancer tissue and adjacent normal gastric tissue and to analyze the correlations between the clinicopatholoic factors of gastric cancer and tumor angiogenic activity. METHODS: Sets of both tumor tissue and adjacent normal gastric tissue were sampled from 49 patients with gastric cancer at the time of gastrectomy. Each specimen was evaluated for the expression of VEGF mRNA by reverse transcriptase polymerase chain reaction (RT-PCR). For the microvessel count of each tissue sample, immunohistochemical staining was done using antiCD31 antibody. As a control group, 10 paraffin blocks of normal gastric tissue from patients with benign disease were selected and stained with the same antibody in order to count the microvessels. RESULTS: The microvessel count of the tumor tissue was higher than that of normal tissue, with a mean+/-SD of 74.10+/-30.33 and 24.69+/-10.11, respectively (p<0.001). The microvessel count of the control group was 23.40+/-6.77 and was not significantly different from that of normal tissue samples taken from patients with gastic cancer. VEGF/beta actin ratios measured from the results of RT-PCR were 0.70+/-0.32 in tumor tissue and 0.51+/-0.26 in normal tissue (p<0.001). In each tissue sample, there was a significant correlation between the microvessel count and VEGF/beta actin ratio (p<0.01 in the tumor tissue, p<0.05 in normal tissue). Micro-vessel count of tumor tissue was related with sex and types of Lauren's classification (p<0.05, p<0.01, respectively). The VEGF/beta actin ratio of tumor tissue was related to sex and degree of vascular invasion of tumor cells (p<0.05). Other clinicopathologic factors, such as age, histologic type, TNM stage, tumor depth, lymph node metastasis, and perineural invasion, were not associated with the degree of microvessel count and the level of VEGF mRNA expression. CONCLUSION: Gastric cancer shows marked angiogenic activity and the angiogenesis is related to some clinicopathologic factors. These results suggest that the clinical application of antiangiogenic agents may have a role in the treatment of gastric cancer.

Expressions of Multidrug Resistance-Related Genes in Gastric Cancer Tissue and Normal Gastric Mucosal Tissue / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to evaluate the expressions of the mdr1 gene and the MRP gene in tumor and adjacent normal gastric tissues. MATERIALS AND METHODS: The specimens were obtained from 53 patients who had gastric cancer. None of these patients had received any kind of preoperative chemotherapy. The reverse transcription polymerase chain reaction and immunohistochemical stain were used to check the level of expressions of mRNAs and their associated proteins. RESULTS: Highly positive expressions of mdr1 mRNA, MRP mRNA, p-glycoprotein, and MRP (multidrug resistance associated protein) were observed in the tumor and the adjacent normal tissues. Most tumor tissues coexpressed mdr1 mRNA and MRP mRNA significantly (p<0.001). The expression of these genes in the tumor was much stronger than in the normal counterpart tissues. The expression of the p-glycoprotein was correlated only with the pathological stage (p<0.05). MRP expression was correlated with lymph node metastasis (p<0.05). CONCLUSION: Normal gastric tissue showed strong physiologic expressions of the mdr1 and MRP genes. Overexpressions of these genes were observed in gastric cancer tissue. The presence of multidrug resistance should be considered when planning anticancer chemotherapy for treating gastric cancer.

Clinical Significance of Tumor Angiogenesis in Gastric Carcinoma

BACKGROUND: The aim of present study is to define the relationship of microvessel density to clinicopathologic data, the recurrence rate and the overall survival in patients with gastric carcinomas. METHODS: Sixty-two patients with gastric carcinomas who underwent a gastrectomy at Yeungnam University Hospital during one year (January to December 1991) were evaluated. Immunohistochemical staining with the factor VIII-related antigen (Dako, USA) was used to assess of angiogenesis. RESULTS: Microvessel counts increased in proportion to lymph-node metastases, perineural invasion, and lymphatic invasion. Histologic type, primary tumor invasion, stage and distant metastasis did not correlate statistically with microvessel counts. The microvessel counts increased with higher pathologic stages, but the difference was not statistically significant. The microvessel counts were significantly higher in the group with LN metastasis than in those without LN metastasis (p or =62), the overall 5-year survival rate was shorter than in those with low microvessel counts (<62), but the difference was not statistically significant. The microvessel counts were higher in the group with recurrence than in those without recurrence. CONCLUSIONS: On the basis of these results, microvessel count may be a prognostic indicator of gastric carcinomas.

Clinical Significance of Lymphocyte Subpopulations in Peripheral Blood from Gastric Cancer Patients

BACKGROUND : There are plenty of documented observations of gastric cancer patients having suppressed cellular immunity, and this immunity may be correlated to recurrence. We studied the changes in the peripheral T-lymphocyte subpopulations in gastric cancer patients and their predictive roles for recurrence. METHODS : Lymphocyte subpopulations in peripheral blood from thirty-eight gastric cancer patients who were operated on at Taegu Catholic Medical Center from September 1995 to February 1997 were measured by 3-color direct immunofluorescence analysis with a Coulter S-plus IV automatic counter. RESULTS : CD4 significantly increased with tumor size and depth of invasion although other immune parameters, such as CD8, CD19, the CD4/CD8 ratio, and total lymphocyte count did not changed. In the patients with lymph-node metastasis, increases in CD3 and CD4 and a decrease in CD19 were observed. CD19 and the B lymphocyte count also decreased in advanced gastric cancer patients. However, T-lymphocytes subpopulations did not significantly change with stage. There were significant decreases in CD8 and in the T- & B-lymphocyte counts, without changes in CD4 and the CD4/CD8 ratio in the postoperative immune parameters.The preoperative values of the T- & B-lymphocyte counts and CD8 and CD19 were lower in patients who had recurrences during six months to two years of follow up, compared to recurrence-free patients. CONCLUSIONS : On the basis of these results, we found changes of T-lymphocyte subpopulations with size, depth of invasion, and regional lymph node metastasis, but not with stage. Postoperatively, there were significant decreases in the T- & B-lymphocyte counts. Suppressed immunity correlated with recurrence, and preoperative evaluation of peripheral T-cell subpopulations may be helpful for predict recurrence and for postoperative prognosis.