Gastric ischemia after epinephrine injection in a patient with liver cirrhosis.

Endoscopic epinephrine injection is relatively easy, quick and inexpensive. Furthermore, it has a low rate of complications, and it is widely used for the management of nonvariceal upper gastrointestinal bleeding. There have been several case reports of gastric ischemia after endoscopic injection therapy. Inadvertent intra-arterial injection may result in either spasm or thrombosis, leading to subsequent tissue ischemia or necrosis, although the stomach has a rich vascular supply and the vascular reserve of the intramural anastomosis. In addition to endoscopic injection therapy, smoking, hypertension and atherosclerosis are risk factors of gastric ischemia. We report a case of gastric ischemia after submucosal epinephrine injection in a 51-year-old woman with hypertension and liver cirrhosis.

Splenic infarction associated with sorafenib use in a hepatocellular carcinoma patient.

Sorafenib, a multitargeted tyrosine kinase inhibitor, has been shown to improve survival in patients with advanced hepatocellular carcinoma (HCC). As the clinical use of sorafenib increases, many adverse effects have been reported, such as hand-foot skin reaction, diarrhea, anorexia, asthenia, alopecia, weight loss, hypertension and arterial thromboembolism. However, there are no prior reports of splenic infarction as an adverse effect of sorafenib. Here, a case of splenic infarction in a patient with HCC who was treated with sorafenib is reported. The patient had no other predisposing factors to explain the splenic infarction except for the administration of sorafenib. The splenic infarction improved after sorafenib was discontinued; however, the HCC progressed.

Efficacy of I-scan endoscopy in the diagnosis of gastroesophageal reflux disease with minimal change.

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved. METHODS: The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change. RESULTS: A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25). CONCLUSIONS: The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.

Segmental tissue Doppler image-derived tei index in patients with regional wall motion abnormalities.

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.

Expression of VEGF, EGFR, and IL-6 in gastric adenomas and adenocarcinomas by endoscopic submucosal dissection.

BACKGROUND: The degree of intratumoral microvascular density is thought to affect tumor metastasis and prognosis in various human cancers, including gastric cancer. Despite recent medical advancements, gastric adenoma or adenocarcinoma remains a considerable therapeutic challenge. Endoscopic submucosal dissection (ESD) is a more recent approach that is now commonly used for radical resection of gastric adenoma and adenocarcinoma. AIM AND METHODS: The expression of vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), and interleukin-6 (IL-6) are related to the prognosis of gastric adenocarcinoma. However, the expression of these factors in gastric adenoma/adenocarcinoma following ESD has not been clearly evaluated. Here, we report on our study of the expression of VEGF, EGFR, and IL-6 by immunohistochemical staining in extracted tissue from adenoma or adenocarcinoma of the stomach by ESD and subsequent evaluation of the correlation of VEGF, EGFR, and IL-6 with other clinicopathological parameters. The patient cohort consisted of 102 patients with adenoma or adenocarcinoma of the stomach. RESULTS: Immunohistochemical staining for VEGF and IL-6 was significantly higher in both high grade dysplasia and adenocarcinoma than in low grade dysplasia (P < 0.05). There was significant correlation between histological grade and intensity of immunohistochemical staining of VEGF (P = 0.039). Histological differentiation of adenocarcinoma was related to IL-6 expression (P = 0.028). The immunoreactivity of VEGF and IL-6 increased significantly in lesions >2 cm compared to lesions <2 cm (P < 0.05). CONCLUSION: The immunohistochemical expression of IL-6 and VEGF can be considered to be useful for clinical diagnosis and follow-up of adenoma or adenocarcinoma of the stomach.