Gastrointestinal Stromal Tumour: Retrospective Study in a Tertiary Care Hospital

Aim: Now GIST is recognised as the most common mesenchimal tumour of the GI tract, though until recently this clinical entity was ill defined. The aim was to study the incidence mode of clinical presentation, type of surgery and histopathological study of the tumour. Methods: This study was carried out on 40 patients at SCB Medical College, Cuttack, Odisha. Results: Incidence sex and anatomical site affected, is nearly same to international statistics. Conclusion: Highest incidence of GIST is in between50-60 years with male predominance. Most of the patients were resectable with spindle type as the most common histological type.

Gastric Volvulus with Eventration of Diaphragm

Gastric volvulus with eventration of diaphragm is an uncommon occurrence. We report here case of a middle-aged woman who came with left-sided chest pain since 1 month, and occasional history of breathlessness in supine position. She was advised to have chest radiograph and ECG done. ECG was within normal limits. On chest radiograph, there was smooth, round, well-defined elevation of left hemidiaphragm with air fluid levels below it. Mediastinum was shifted towards right side. Based on that, barium meal was advised which showed contrast filling with alteration of axis of stomach. Organoaxial type of gastric volvulus is confirmed.

Panorama of neoplasms of upper GI tract: a 5 year research study.

Background: The diseases of the gastrointestinal tract (GIT) are the most common and leading cause of morbidity and mortality than the disorders of any other systems of the body. Gastrointestinal (GI) tract tumors are one of the most common cancers accounting for 11% of all cancers. Among these tumors, upper gastrointestinal tract malignancies are quite aggressive with a dismal prognosis. Malignant tumors are most common than benign. The most common carcinoma of the esophagus is Squamous cell carcinoma (SCC). Incidence of SCC is less than 5 per 100,000 populations in males and 1 per 100,000 populations in females. Gastric cancer was the second most common cancer in the World and 60% of them occurred in developing countries. The most common carcinoma of the Stomach is Adenocarcinoma. Aim & Objectives: To study the spectrum of neoplastic lesions of the upper gastrointestinal tract by the examination of endoscopic biopsies and surgically resected specimens. To determine the degree of severity of the malignancies by assessing the depth of invasion, Lymph nodal & Omental spread. Methods: The present study is both retrospective & prospective study for a period of 5 years from January 2007 to December 2011. The sample size includes all the endoscopic biopsies & surgically resected specimens of gastrointestinal tract received at Department of Pathology, S.V. Medical College, Tirupati. The study also obtained clearance from the ethical committee of the institution. The biopsy specimens thus obtained were fixed in 10% buffered neutral formalin. The sections were stained routinely with H & E. Special stains and IHC done wherever necessary. Results: we have received 120 specimens regarding the upper gastrointestinal system. Among these 120 specimens, 71 specimens were endoscopic biopsies & 49 specimens were surgically resected specimens. Out of 71 Endoscopic biopsies 28 biopsies were malignant among which 2 was esophagus and 26 were stomach. Out of 49 surgically resected specimens 1 was benign and 32 were malignant tumors. Out of 59 neoplasms of stomach there were single cases each of Sub mucosal Lipoma, Malignant lymphoma, GIST & 56 cases of Adenocarcinoma & its variants were noted. Conclusion: Most of the neoplasms are of stomach (97%). All the neoplasms are malignant except one benign lesion sub mucous lipoma of stomach. Most of the neoplasms of stomach were Adenocarcinoma (96.5%). Both tumors of esophagus were squamous cell carcinoma occurred after 50 years of age.

Effect of dihydrotestosterone on gastrointestinal tract of male Alzheimer’s disease transgenic mice.

The cause of Alzheimer’s disease (AD) is still unknown. While research contributions identifying brain as locus of the disease is growing, evidence of severely impaired gastrointestinal (GI) functions with ageing too is accumulating, there is an equal dearth of information on GI tract in AD condition. The aim of this study was to assess the molecular, histological, morphological and microflora alterations of GI tract in male Alzheimer’s transgenic mice. The present study also investigates the effect of dihydrotestosterone (DHT) treatment (1 mg/kg) on AD mice. Histoarchitecture data revealed a significant decrease in the villi number, muscular layer thickness, villi length, width, crypt length, enterocyte length and nuclei length. A shift in colon feces microbial community composition was observed by fatty acid methyl ester analysis. Amyloid precursor protein (APP) expression levels in intestine significantly increased in AD mice revealing its toxicity. DHT treatment attenuated the effect caused by AD on GI morphometrics, APP expression and colon micro flora population. These results for the first time reveal the quantitative and qualitative characteristics of GI tract in male Alzheimer’s disease transgenic mice.

Relaxation Patterns of Human Gastric Corporal Smooth Muscle by Cyclic Nucleotides Producing Agents

To elucidate the mechanism of cyclic nucleotides, such as adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5' -cyclic monophosphate (cGMP), in the regulation of human gastric motility, we examined the effects of forskolin (FSK), isoproterenol (ISO) and sodium nitroprusside (SNP) on the spontaneous, high K+ and acetylcholine (ACh)-induced contractions of corporal circular smooth muscle in human stomach. Gastric circular smooth muscle showed regular spontaneous contraction, and FSK, ISO and SNP inhibited its phasic contraction and basal tone in a concentration-dependent manner. High K+ (50 mM) produced sustained tonic contraction, and ACh (10 micrometer) produced initial transient contraction followed by later sustained tonic contraction with superimposed phasic contractions. FSK, ISO and SNP inhibited high K+-induced tonic contraction and also ACh-induced phasic and tonic contraction in a reversible manner. Nifedipine (1 micrometer), inhibitor of voltage-dependent L-type calcium current (VDCC(L)), almost abolished ACh-induced phasic contractions. These findings suggest that FSK, ISO and SNP, which are known cyclic nucleotide stimulators, inhibit smooth muscle contraction in human stomach partly via inhibition of VDCCL.

Voltage-dependent Ca2+ Current Identified in Freshly Isolated Interstitial Cells of Cajal (ICC) of Guinea-pig Stomach

The properties of voltage dependent Ca2+ current (VDCC) were investigated in interstitial cells of Cajal (ICC) distributed in the myenteric layer (ICC-MY) of guinea-pig antrum. In tissue, ICC-MY showed c-Kit positive reactions and produced driving potentials with the amplitude and frequency of about 62 mV and 2 times min(-1), respectively, in the presence of 1micrometer nifedipine. Single ICC-MY isolated by enzyme treatment also showed c-Kit immunohistochemical reactivity. These cells were also identified by generation of spontaneous inward current under K+-rich pipette solution. The voltage clamp experiments revealed the amplitude of - 329 pA inward current at irregular frequency. With Cs+-rich pipette solution at Vh=?80 mV, ICC-MY produced voltage-dependent inward currents (VDIC), and nifedipine (1micrometer) blocked VDIC. Therefore, we successfully isolated c-Kit positive single ICC from guinea-pig stomach, and found that ICC-MY potently produced dihydropiridine sensitive L-type voltage-dependent Ca2+ currents (VDCCL).

The Potential Effect of Ubai-en on Protein-losing Enteropathy / 日本東洋医学雑誌

A 64-year-old female who had suffered from rheumatoid arthritis (RA) for many years was admitted to our hospital because of acute abdominal pain and diarrhea. She was diagnosed with RA, Sjögren syndrome and protein-losing enteropathy (PLE) with GI tract amyloidosis. She was treated with total parenteral nutrition, prednisolone, tranexamic acid and a variety of Kampo medicines, for example: kanzo-syashin-to, keishi-kashakuyaku-shoukyou-ninjin-to, and bushi-kobei-to. However, diarrhea continued and paralytic ileus occurred. Then she was treated with Ubai-en, which is known as an anti-ascarid drug or anti-diarrheic drug. Ubai-en was effective on her diarrhea in 2 weeks. This suggests that Ubai-en may be an effective treatment for PLE.

Diagnosis and Treatment of Adult Intussusception Due to Gastrointestinal Lipoma

PURPOSE: In contrast to childhood intussusception, adult intussusception is a rare disease and usually has a specific etiology. Malignancy is the leading cause, and gastrointestinal lipoma has been infrequently reported as a cause of adult intussusception. However, GI lipoma can be easily diagnosed by current radiologic studies and can be managed less aggressively than intussusception with a malignant etiology. METHODS: 5 adult (above 16 years old) patients have been identified to be operated on from January 1990 to June 1999 in Korea University Hospital due to intussusception caused by gastrointestinal lipoma. Their preoperative radiologic findings, operative methods and clinical results were analyzed, retrospectively. RESULTS: There were 3 male and 2 female patients, and the mean age was 49. Simple abdominal X-rays were taken in all 5 patients, and mechanical obstructive patterns were present in 4 cases. Abdominal CT or ultrasonography was performed in 4 patients preoperatively and demonstrated a lipoma in 3 cases (75%). In one patient, who showed toxic signs caused by mechanical intestinal obstruction, emergency exploration was undertaken without further preoperative radiologic study. The lipoma was located at the jejunum in 1 case, at the ileum in 2 cases and at the cecum in 2 cases. Resection of the involved segment of the bowel after reduction of intussusception was done in 3 cases and resection of involved bowel without reduction was done in the remaining 2 cases. Consequently, segmental resection of the small bowel was performed in 2 cases and a right colectomy in 3 cases. There was no postoperative morbidity or mortality. CONCLUSION: Adult intussusception caused by a gastrointestinal lipoma can be easily diagnosed by using CT or ultrasonography. It can be safely managed through reduction and resection of the lesion unless there is strangulation.

Detection and Subtyping of Epstein-Barr Virus in Gastrointestinal Adenocarcinomas and Malignant Lymphomas

Epstein-Barr virus (EBV) has been linked to a spectrum of neoplastic conditions, including Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkin's disease, lymphoepithelioma-like carcinomas and malignant lymphomas in immunocompromised state. To determine the prevalence and the subtype of EBV in gatrointestinal malignancies, fifty cases of adenocarcinomas and seventeen cases of malignant lymphomas were analyzed by EBERs in situ hybridization and polymerase chain reaction using primers for EBNA-1, EBNA-2A and EBNA-2B, on the paraffin sections. In addition, immunohistochemical stain for p53 protein was performed to investigate the potential role of EBV infection on tumor suppressor gene, p53, during tumorigenesis. EBER was detected in 6 of 26 gastric adenocarcinomas, 2 of 24 colon adenocarcinomas, and 8 of 17 malignant lymphomas. EBER was more prevalent in malignant lymphoma arising in the intestine (6/6) than in the stomach (2/11), and was detected in both B and T cell phenotypes. EBNA-1 was positive in 11 of 16 EBER positive cases and the subtyping was possible in 8; both type 1 and 2 were detected in gastric cancers, whereas only type 2 was found in intestinal neoplasms. In adenocarcinomas the high rate of p53 protein overexpression was found in both EBER positive (8/8) and negative cases (32/42), whereas the positive rate was higher in EBER positive cases (7/8) than in EBER negative cases (4/9) of malignant lymphomas. From the results, it can be concluded that EBV infection and the p53 tumor suppressor gene are independently associated in a significant portion of the gastrointestinal malignancies, but the mechanism of action remains to be elucidated.

Endoscopic Removal of Foreign Bodies in Upper GI Tract in Children

PURPOSE: The foreing bodies in the upper GI tract are chiefly caused by accidental swallowing and rarely provoke symptoms. It is recommended to remove the foreign bodies if they produce symptoms or remain in GI tract for long duration or complications are expected to bring about. Nowadays the development of pediatric therapeutic endoscopy enables the removal of the foreign bodies in upper GI tract easily. METHODS: A clinical study of 30 cases of pediatric patients with the foreign bodies in the upper gastrointesinal tract diagnosed by the endoscopy at Seoul Red Cross hospital from January 1991 to December 1995 was perforemed. RESULTS: 1) The ages ranged from 1 year to 9 years and the male to female ratio was 2.3:1. 2) The types of ingested foreign bodies were coins (63.3%), audiokeys (10.0%), plastic toy (3.3%), earphone cap (3.3%), metal (3.3%), screw (3.3%), and battery (3.3%). Eighteen cases (60.0%) were located in the 1st narrowing part of the esophagus and 10 cases (33.3%) were in the stomach 3) Presenting symptoms were asymptomatic in 46.7%, dysphagia in 20.0%, vomiting in 16.7%, sore throat in 10.0%, and poor oral intake in 10.0%. The most common symptom in the cases of gastric foreign bodies was asymptomatic (90%), and common symptoms in the cases of 1st esophageal foreign bodies were dysphagia (33.3%), vomiting (27.8%) and asymptomatic (27.8%). 4) Abnormal endoscopic findings were erosive gastritis (16.7%), erosive esophagitis (6.7%), esophageal ulcer (3.3%), esophagitis (3.3%), and pharyngeal necrosis (3.3%) in order. CONCLUSIONS: The upper GI endoscope is a safe and essential method to diagnose and treat foreign bodies in the upper GI tract in pediatric patients.

A Case of Nonfamilial Generalized Gastrointestinal Juvenile Polyposis with Pancytopenia

In contrast to the child with a solitary juvenile polyp, generalized gastrointestinal juvenile polyposis have a much different clinical course. In generalized juvenile polyposis blood loss can be considerable and iron-deficiency anemia is a common observation. Although it is usually regarded as a benign condition, juvenile polyposis may predispose to cancer of the gastrointestinal tract. We experienced a case of nonfamilial generalized gastrointestinal juvenile polyposis with pancytopenia in a 15 year-old male patient who had hospitalized because of intermittent rectal bleeding with anemia for three years. Histological examination of polyps from affected patient revealed a spectrum of change from juvenile polyps, to juvenile polyps with adenomatous changes. Subtotal colectomy, rectal mucosectomy, and endorectal pull-through procedure were successfully performed. No complication has occured since the discharge. A brief review of related literatures is also presented.