Gastrointestinal complications after radiation therapy in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: With the recent technical advancement to deliver high doses of radiation to a liver mass, radiation treatment has been increasingly used in patients with hepatocellular carcinoma. The aim of this study was to investigate the clinical characteristics of the gastrointestinal adverse effects after radiation therapy in patients with hepatocellular carcinoma. METHODOLOGY: Between 1994 to 2002, 153 patients with hepatocellular carcinoma have been treated with radiation therapy. Medical records were systemically reviewed. RESULTS: Upper endoscopic examinations were done in 34 patients. Radiation-induced ulcers were found in the stomach (n=9) and duodenum (n= 14). Radiation-induced gastroduodenitis was found in 9 patients. Bleeding from radiation-related lesions in 11 patients (7.2%) was caused by gastroduodenitis (n=7), gastric ulcer (n=2), and duodenal ulcer (n=2). There were 7 patients with rebleeding. Bleeding was fatal in only one patient. Two patients with obstruction were treated by stent insertion. Two patients with perforation improved after surgical repair. Hematologic toxicity was found in 53 patients (34.6%) and hepatobiliary complications were found in 40 patients (26.1%). Radiation-induced pneumonitis was found in 3 patients (2%). CONCLUSIONS: We found that radiation-induced complications in patients with hepatocellular carcinoma are rather frequent. However, most complications were effectively managed by intensive treatments including endoscopic hemostasis, stent insertion and surgery.

Plasma adiponectin and insulin resistance in Korean type 2 diabetes mellitus.

Insulin resistance, which implies impairment of insulin signaling in the target tissues, is a common cause of type 2 diabetes. Adipose tissue plays an important role in insulin resistance through the dysregulated production and secretion of adipose-derived proteins, including tumor necrosis factor-alpha, plasminogen activator inhibitor-1, leptin, resistin, angiotensinogen, and adiponectin. Adiponectin was estimated to be a protective adipocytokine against atherosclerosis, and also to have an anti-inflammatory effect. In this study, the relationship between fasting plasma adiponectin concentration and adiposity, body composition, insulin sensitivity (ITT, HOMAIR, QUICK), lipid profile, fasting insulin concentration were examined in Korean type 2 diabetes. The difference in the adiponectin concentrations was also examined in diabetic and non-diabetic subjects, with adjustment for gender, age and body mass index. 102 type 2 diabetics and 50 controls were examined. After a 12-h overnight fast, all subjects underwent a 75 gram oral glucose tolerance test. Baseline blood samples were drawn for the determinations of fasting plasma glucose, insulin, adiponectin, total cholesterol, triglyceride, LDL-cholesterol, and HDL-cholesterol. The body composition was estimated using a bioelectric impedance analyzer (Inbody 2.0). The insulin sensitivity was estimated using the insulin tolerance test (ITT), HOMAIR and QUICK methods. In the diabetic group, the fasting adiponectin concentrations were significantly lower in men than in women. They were negatively correlated with BMI (r=-0.453), hip circumference (r=-0.341), fasting glucose concentrations (r=-0.277) and HOMAIR (r= -0.233). In addition, they were positively correlated with systolic blood pressure (r=0.321) and HDL-cholesterol (r= 0.291). The systolic blood pressure and HDL-cholesterol were found to be independent variables, from a multiple logistic regression analysis, which influenced the adiponectin concentration. Compared with the non-diabetic group, the adiponectin concentrations were significantly lower in the diabetic group, with the exception of obese males. In conclusion, the plasma adiponectin concentrations were closely related to the insulin resistance parameters in Korean type 2 diabetic patients.