Clinical Characteristics and Outcomes of Geriatric Patients in Upper Gastrointestinal Bleeding

BACKGROUND: The incidence of upper gastrointestinal bleeding has decreased in the general population but has increased in geriatric patients worldwide. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with upper gastrointestinal bleeding and to compare them with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 288 patients with upper gastrointestinal bleeding from January 2007 to August 2010. We compared the clinical characteristics and outcomes of geriatric patients (n=148, 51.4%) with those of non-geriatric patients (n=140, 48.6%). RESULTS: Cardiovascular disease, hypertension, and cerebrovascular accidents were more prevalent in the geriatric group, compared with those in the non-geriatric group (p<0.05). Vital signs were more unstable in the geriatric group than those in the non-geriatric group (p<0.05). The geriatric group had taken more ulcerogenic drugs than those in the non-geriatric group (p<0.05). The most common cause of upper gastrointestinal bleeding was peptic ulcer (72.3%) in the geriatric group, whereas it was variceal bleeding (41.4%) in the non-geriatric group. Treatment methods, transfusion volume, operation rate, and mortality were not different between the two groups. The length of hospital stay and length of intensive care unit (ICU) stay were significantly longer in geriatric patients than those in the non-geriatric group (p<0.05). CONCLUSION: Geriatric patients with upper gastrointestinal bleeding had longer ICU and hospital stays than those of non-geriatric patients. Important emerging etiologies such as ulcerogenic drugs and associated chronic illness should be monitored and treated early in these patients.

Inhibitors of Apoptosis Proteins Expression and Their Prognostic Significance in Colorectal Carcinoma

BACKGROUND: The expression of the inhibitor of apoptosis proteins (IAPs) family has not been fully investigated in colorectal carcinomas. This study investigated IAP expression in colorectal carcinomas and assessed their prognostic significance. METHODS: Livin, XIAP, and SMAC/DIABLO expression was assessed by immunohistochemistry in 159 colorectal carcinomas. Correlations between protein expression and clinicopathological features were evaluated. The survival data analysis was estimated according to the Kaplan-Meier method. RESULTS: Increased expression of IAPs in cancer tissues compared to surrounding nonneoplastic counterparts was observed in 67 cases (42.1%) for Livin, 50 cases (31.4%) for XIAP, and 68 cases (42.8%) for SMAC. A significant correlation was found between Livin expression and tumor differentiation, and SMAC expression and tumor location. The recurrence-free and overall survival of patients with low Livin expression were inferior to those of patients with high Livin expression (p=0.054 and 0.095, respectively). High XIAP expression was significantly associated with shorter progression-free survival (p= 0.041). CONCLUSIONS: Our study demonstrated that altered expression of IAP family members, including Livin, XIAP, and SMAC, is frequent in colorectal carcinoma. This result suggests that high Livin expression and low XIAP expression may be a favorable prognostic implication related to patient survival.

Prognostic Value of Phosphorylated Akt and Survivin Expression in Gastric Adenocarcinoma

BACKGROUND: pAkt (the phosphorylated form of the proto-oncogene protein c-akt) and survivin (human BIRC5 protein) are candidate apoptosis-related molecules that may be responsible for cancer progression. The aim of this study was to determine the expression of pAkt and survivin in malignant stomach neoplasm, and their value as prognostic indicators of cancer. METHODS: The expression of pAkt and survivin in 144 cases of gastric cancer was detected by immunohistochemistry and compared with established clinicopathological parameters and prognosis of this disease. RESULTS: Expression of pAkt showed significant correlations with depth of invasion, lymph node and distant metastasis, as well as the stage (p < 0.05 for all three correlations), but not with the Lauren classification. Survivin expression closely correlated with histological type, Lauren classification, depth of invasion, metastasis, and stage (p < 0.05 for all). The overall survival of patients with pAkt/survivin expression was inferior to that of patients with loss of pAkt/survivin expression. Cox multivariate analysis demonstrated a significant correlation between stage (p = 0.04), survivin expression (p = 0.02), and prognosis. CONCLUSIONS: Patients with pAkt/survivin expression in gastric cancer are at increased risk of cancer-related mortality via the apoptosis resistance pathway. Expression of pAkt and survivin could be used as a prognostic indicator for gastric cancer.