Takayasu's arteritis associated with Crohn's disease.

Takayasu's arteritis (TA), also known as the "pulseless disease," is a chronic vasculitis of the aorta and aortic branches. TA with Crohn's disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu's arteritis associated with concurrent Crohn's disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autologous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn's disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn's disease may be associated with immune disorders, especially autoimmunity.

Is adult celiac disease really uncommon in Chinese?

Celiac disease (CD) is a type of intestinal malabsorption syndrome, in which the patients are intolerant to the gliadin in dietary gluten, resulting in chronic diarrhea and secondary malnutrition. The disease is common in Europe and the United States, but only sporadic reports are found in East Asia including China. Is CD really rare in China? We examined 62 patients by capsule endoscopy for chronic diarrhea from June 2003 to March 2008. Four patients with chronic diarrhea and weight loss were diagnosed to have CD. Under the capsule endoscopy, we observed that the villi of the proximal small bowel became short, and that the mucous membrane became atrophied in these four patients. Duodenal biopsies were performed during gastroscopy and the pathological changes of mucosa were confirmed to be Marsh 3 stage of CD. A gluten free diet significantly improved the conditions of the four patients. We suspect that in China, especially in the northern area where wheat is the main food, CD might not be uncommon, and its under-diagnosis could be caused by its clinical manifestations that could be easily covered by the symptoms from other clinical situations, particularly when it came to subclinical patients without obvious symptom or to patients with extraintestinal symptoms as the initial manifestations.

A systematic review and meta-analysis of the treatment for Barrett's esophagus.

As evidence-based strategies to the clinical management of Barrett's esophagus (BE) are lacking, we have carried out a systematic review and meta-analysis of all published randomized controlled trials with the aim of evaluating the value of different approaches in the treatment of BE. Searches were conducted in the databases PUBMED, EMBASE, and Cochrane Library. Thirteen randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were assessed in more detail. Based on our search, neither the pharmacological nor surgical therapies currently available for reflux appear to achieve complete regression of BE and the elimination of the cancer risk associated with it. In contrast, endoscopic ablative techniques are capable of achieving endoscopic and histological reversal of BE, with ablation by argon plasma coagulation (APC) appearing to be more effective than treatment with photodynamic therapy (PDT) [odds ratio (OR) 3.46, 95% confidence interval (CI) 1.67-7.81, P = 0.0008]. There was no statistically significant difference between APC and multipolar electrocoagulation (MPEC) in terms of the efficacy to achieve regression of BE (OR 2.01, 95% CI 0.77-5.23, P = 0.15). In conclusion, there have been only a limited number of randomized controlled trials that compare treatments for BE. The pharmacological therapy, antireflux surgery, and endoscopic ablative techniques are promising in terms of treating BE, but the studies carried out to date have had no adequate power to assess the effect of treatment on reducing and preventing progression to adenocarcinoma.

Expression of p53, p16 and cyclooxygenase-2 in esophageal cancer with tissue microarray.

OBJECTIVE: The aim of this study was to obtain a comprehensive survey on the expression of p53, p16 and cyclooxygenase-2 (COX-2) in esophageal cancer progression and their clinical significance. METHODS: A tissue microarray containing 86 specimens from esophageal cancer and 40 specimens from adjacent non-cancer tissue was constructed to survey the expression of p53, p16 and COX-2 by immunohistochemistry. The influence of each biomarker on the histotype of esophageal lesion was assessed by logistic regression analysis. RESULTS: The expression of p53 and COX-2 was significantly higher in tumorous tissue than in non-tumorous tissue. As to p16, no significant difference was detected between tumorous and non-tumorous tissue. A significant correlation was observed among p53, COX-2 and p16 expression. Logistic regression analysis revealed that the risk factors of a tumorous histotype were the positive expression of p53 (odds ratio [OR] = 18.214) or COX-2 (OR = 42.703), and no reciprocal relationship to neoplastic progression was recognized with p53, p16 and COX-2. CONCLUSIONS: p53 and COX-2 were independent predictors in esophageal carcinogenesis. Esophageal tissue with a positive expression of p53 or COX-2 was more likely to develop esophageal cancer.

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

Expression of p53, p16 and COX-2 in pancreatic cancer with tissue microarray.

BACKGROUND: Pancreatic cancer development and progression is driven by the accumulation of genetic changes. In this study we constructed tissue microarray containing specimens from pancreatic cancer, adjacent non-cancer tissue and normal tissue to survey the expression of p53, p16 and cyclooxygenase-2 (COX-2). METHODS: Tissue microarray containing 337 specimens from different stages of pancreatic cancer, adjacent non-cancer tissue and normal tissues was constructed, and the expression of p53, p16 and COX-2 was assayed by immunohistochemistry to consecutive formalin-fixed tissue microarray sections. RESULTS: The expression of p53, p16 and COX-2 was significantly higher in tumorous tissues than in non-tumorous ones. A significant relationship was observed between p53 and COX-2, or p16 and COX-2. But no obvious correlation was seen between p53 and p16 expressions. Logistic regression analysis showed p53 and COX-2 as dependent predictors in pancreatic carcinogenesis, and a reciprocal relationship to neoplastic progression between p53 and COX-2. CONCLUSION: Combination analysis of p53 and COX-2 may be useful in predicting pancreatic carcinogenesis.

Determination of serum carbohydrate-deficient transferrin in the diagnosis of alcoholic liver disease.

BACKGROUND: Alcoholic liver disease (ALD) is a serious and potentially fetal consequence of alcohol use. The diagnosis of ALD is based on alcohol consumption, physical signs and symptoms, and laboratory tests. The aim of the present study was to assess the reliability of carbohydrate-deficient transferrin (CDT) in the diagnosis of ALD. METHODS: According to the diagnostic criteria for ALD by the Chinese Medical Association in 1995, 76 patients with ALD, 55 patients with alcoholism, 32 patients with nonalcoholic liver disease (NALD), and 27 healthy subjects (controls) were studied. Serum CDT was assayed by isoelectric focusing immunofixation and Comassie blue staining. The levels of alamine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyltransferase (GGT) were also examined. RESULTS: The positive rate of CDT in the patients with ALD was 93.4%(71/76), which was higher than that in those with alcoholism (52.7%, 29/55, P<0.001), in those with NALD(9.4%, 3/32, P<0.001), and in healthy controls, respectively. The sensitivity and specificity of CDT for ALD was 93.4% and 71.9%, respectively. CONCLUSION: CDT may help diagnose alcoholic liver disease.

Correlation of polymorphism in the interleukin-1 receptor antagonist gene intron 2 with alcoholic liver disease.

BACKGROUND: Interleukin-1 receptor antagonist (IL-1ra) can inhibit the pro-inflammatory effects of IL-1, which recently has been thought to involve the pathogenesis of alcoholic liver disease (ALD). This study was undertaken to determine whether there is any association between IL-1ra gene polymorphism and ALD in a Chinese population. METHODS: The polymorphism of IL-1ra gene intron 2 (VNTR) was assessed in 165 alcoholics (43 alcohol-dependent subjects without liver diseases, 30 patients with alcoholic fatty liver, 61 patients with alcoholic hepatitis and 31 patients with alcoholic cirrhosis) and 65 healthy control subjects by PCR with DNA of peripheral blood mononuclear cells. RESULTS: The rate of IL-1RN*1 carriage was statistically higher in the alcoholics than in the control group (98.79% vs 93.85%, chi2=4.48, P<0.050). And the IL-1RN*1 allele frequency was more common in the alcoholics than in the control group (86.67% vs 76.92%, chi2=6.56, P<0.025). IL-1RN*1 heterozygote was significantly more frequent in the patients with alcoholic hepatitis or those with cirrhosis than in the alcohol-dependent subjects without liver diseases (32.79%, 29.03% vs 9.30%; chi2=7.84, chi2=4.84; P<0.010, P<0.050). The IL-1RN*2 allele frequency in the patients with alcoholic hepatitis and the patients with cirrhosis was also significantly higher than in those alcoholics without liver diseases (13.93%, 17.74% vs 4.65%; chi2=4.79, chi2=6.78; P<0.050, P<0.010). But the frequencies of IL-1RN*1 heterozygote and IL-1RN*2 allele appear to be not different between the patients with alcoholic fatty liver and the alcoholics without liver diseases. CONCLUSIONS: IL-1ra gene polymorphism is closely associated with race. IL-1RN*2 allele doesn't influence the susceptibility to ALD, but the gene carriers with ALD have additional risk for aggravation of the illness.

[An epidemiological survey of alcoholic liver disease in Zhejiang province].

OBJECTIVE: To describe the brief survey of alcohol intake and the incidence of alcohol liver disease in Zhejiang province. METHODS: 18,237 requested persons aged over 18 years were selected by multi-stage stratified cluster sampling in Zhejiang province. Questionnaire about alcohol consumption, hepatic ultrasonic scan and detection of hepatic enzymes and markers of HBV and HCV were carried out. Daily alcohol intake more than 40g (including equal to 40g/d) was essential for the diagnosis of alcoholic liver disease. RESULTS: Among the 18,237 persons (male 12,042, female 6195), the average daily alcohol intake was (17.7 +/- 27.2) g. The incidence of alcoholic liver disease in Zhejiang province was 4.34% (male 6.36%, female 0.36%) in the whole population. Four subtypes were separated as alcoholic cirrhosis, alcoholic fat liver, alcoholic hepatitis and mild alcoholic injury in liver with the corresponding incidence of 0.68%, 0.94%, 1.51% and 1.21% separately. CONCLUSION: Alcoholic liver disease is found to be a common disease in Zhejiang province, indicating an urgent need for the public education on alcohol abuse and the treatment on related health problems

[Gastrointestinal pacemaking for gastric dynamic disorders].

OBJECTIVE: To investigate the efficacy and safety of gastrointestinal pacemaker in treatment of gastric dynamic disorders. METHODS: Sixty patients with more than two symptoms as postprandial fullness, epigastric pain,epigastric fullness, belch, nausea, hypercoria,anorexia,vomiting and at least for twelve weeks were divided into three groups randomly. Thirty patients were treated with gastrointestinal pacemaker for ten days(pace maker group); fifteen patients were treated with gastrointestinal placebo machine for ten days (control group); fifteen patients received treatment with cisapride 5 mg three times daily, thirty minutes before meal (cisapride group) for ten days. Electrogastrogram(EGG) was performed on before and after treatments, the mean frequency and mean amplitude of EGG, the clinical symptoms and adverse reactions were observed. RESULTS: Total efficacy of pace maker group, control group and cisapride group was 90.0%, 46.6% and 86.7%, respectively. The score of symptoms was significantly decreased after treatment with gastrointestinal pacemaker and cisapride (P<0.05). Before and after meal EGG exam showed that average frequency was reversed to normal level after treatment with gastrointestinal pacemaker. CONCLUSION: Gastrointestinal pacemaking can relieve symptoms and improve the average frequency of EGG in patients with gastric dynamic disorders.