Manometric Investigation of Anorectal Dysfunction in Patients with Progressive Systemic Sclerosis

PURPOSE: The aim of this study was to investigate the anorectal function in patients with progressive systemic sclerosis (PSS), thus to define the clinical role of anorectal manometry in the earlier diagnosis of anorectal involvement of PSS. METHODS: Seventeen consecutive patients (all females) with PSS were evaluated with anorectal manometry by the stationary pullthrough technique using the 8-channel hydraulic capillary infusion system for anorectal function. Functional parameters of the manometry were compared between patients with PSS and 20 normal control subjects, matched for age and sex. RESULTS: The mean resting pressure over the high pressure zone (HPZ) in patients with PSS was significantly lower than that in the control group (70.8 3.4 mmHg vs. 81.5 3.2 mmHg: P=0.046). The HPZ in patients with PSS was also significantly reduced compared with that in the control (1.5 0.1 cm vs. 2.5 0.1 cm: P=0002). The rectoanal inhibitory reflex (RAIR) was detected in only 10 patients (59%) in the PSS group, but was present in all except one (95%) in the control (P=0.022). More interestingly, RAIR in patients with PSS responded at a higher volume of the air insufflated than that in the control (74% vs. 30% at 20 cc, 21% vs. 30% at 30 cc, and 0% vs. 40% at 50 cc, respectively: P=0.031). Other functional parameters, including maximal squeeze pressure, minimal sensory and maximal tolerable volume of the rectum, and rectal compliance were not significantly different between two groups. CONCLUSIONS: Anorectal involvement reflected by the anorectal manometric dysfunction may be rather an earlier event in patients with PSS. An awareness to perform an anorectal manometric study in every case of PSS may be necessary for earlier subclinical detection of anorectal involvement by the disease.

Preliminary Results for Changes in the Expression of Angiogenic Factors with Stage in Gastric Cancer

BACKGROUND: It has been suggested that the expression of angiogenic factors by tumor cells contributes to the increased neovascularization and vessel permeability that are associated with tumor vasculature. However, the significance of protein expression involving tumor angiogenesis in gastric cancer has yet not to be classified. METHODS: In this study, the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (Cox), and nitric-oxide synthase (NOS) were investigated in 14 surgically resected human gastric carci nomas by using western blotting. RESULTS: In 6 of 14 paired cases, VEGF expression in the tumor tissue was slightly increased compared with the nonneoplastic counterpart in the same specimen. However, the expression of inducible-type Cox-2 was significantly increased in tumor tissue while the expression of constitutive-type Cox-1 was decreased. The expression of endothelial-type eNOS in cancer tissue was shown to be higher than in normal gastric resected tissues, but the expression of nNOS in cancer was lower than it was in a normal gastric mucosa. CONCLUSION: Although a direct positive correlation between VEGF expression and cyclooxygenase or nitric oxide synthase was not found in differnt stages of gastric tumor development, the cyclooxygenase and nitric-oxide synthase may play an important role in gastric cancer development.