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Original Article
Acute septic cholelithiasic cholecystitis and adenocarcinoma of the gallbladder ; an interesting associationPrice: €10,00 |
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| Background and study aims : Primary carcinoma of the gallbladder
may present as acute lithiasic cholecystitis that leads to
severe septic complications. The correlation between severe sepsis
of the gallbladder and primary carcinoma is unclear. The goal of
the present study is to examine the relation between severe septic
complications of lithiasic cholecystitis and primary carcinoma of
the gallbladder.
Patients and methods : A group of 72 patients (22 males,
50 females, age range : 45-99, mean age : 68.6 years), with severe
septic cholelithiasic cholecystitis was treated with emergency
surgery after failure of conservative treatment, and patients found
with primary carcinoma of the gallbladder were registered. The
resectability and operability of the tumor were studied, as well as
tumor staging and overall patient survival.
Results : During urgent surgery for severe septic lithiasic cholecystitis,
12 patients (12/72, 16.6%) were found with gallbladder
carcinoma. Patients with septic acute lithiasic cholecystitis and
carcinoma had a higher mean age compared to those without
carcinoma (74.8 vs. 67.4yrs). Eleven of 12 (91.6%) carcinomas
were inoperable, despite resectability of 8 out of 12 (66.6%), and
overall patient survival was limited to a few months after surgery.
Conclusions : Severe septic complications in elderly patients
with a long-standing history of gallbladder stones may co-exist
with primary carcinoma of the gallbladder. The percentage of a
gallbladder carcinoma detected in septic patients reaches up to
16.6%. Even if these patients have a poor general health, surgical
intervention is a solution when they appear with severe septic
clinical symptoms caused by gallstones or carcinoma, in order to
avoid lethal sepsis. The possibility of a carcinoma hidden in the
gallbladder must be in mind during surgery. Imaging studies
before surgery may detect the carcinoma; in most cases carcinomas
are inoperable, although colecystectomy may be performed
during surgery. [Product Details...] |
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Are humoral factors involved in the colonic mucosal lesion in portal hypertensive rats ?Price: €10,00 |
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| Aims : With a prehepatic portal hypertensive rat model, we
explored the involvement of humoral factors to the occurrence of
portal hypertensive colopathy (PHC), another clinical entity
besides portal hypertensive gastropathy (PHG) in portal hypertension,
by investigating the expression of inducible nitric oxide
synthase (iNOS), endothelial constitutive NOS (ecNOS), endothelin-
1 (ET-1), tumour necrosis factor alpha (TNF-a) and vascular
endothelial growth factor (VEGF) in the colonic and gastric
mucosa.
Methods : Portal hypertension was produced by a two-stage ligation
of portal vein plus ligation of the left adrenal vein in male
Sprague-Dawley rats. Two weeks after complete obstruction of the
portal vein, the portal pressure was measured and the expression
of iNOS, ecNOS, ET-1, TNF-a and VEGF in the colonic and gastric
mucosa were detected by RT-PCR and immunohistochemistry
methods.
Results : A 1.8fold (P < 0.01) elevation of the portal pressure was
detected in the portal hypertensive rats as compared to control.
Significantly up-regulation of the mRNA levels of iNOS (P < 0.01),
ET-1 (P < 0.05) and TNF-a (P < 0.01), but not ecNOS and VEGF,
were detected in the colonic mucosa of portal hypertensive rats
compared with control. The mRNA of iNOS, ecNOS, ET-1, TNF-a
and VEGF were all significantly increased at varied levels in the
gastric mucosa as compared to control (P all < 0.05). No difference
of the appearance and localization of immunostaining of iNOS,
ecNOS, ET-1, TNF-a and VEGF in the colonic and gastric mucosa
were seen between two groups.
Conclusions : These data suggest the involvement of the upregulation
of iNOS, ET-1 and TNF-a in the colonic mucosal lesion
of portal hypertensive rats. [Product Details...] |
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Association of the prevalence and grade of steatosis in patients with chronic hepatitis C with the host and viral factorsPrice: €10,00 |
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| Aim : The aim of this study was to investigate the prevalence of
hepatosteatosis in chronic hepatitis C patients, evaluate the potential
impact of some host- and virus-related factors on its occurrence
and possible influence of steatosis on the consequences of
hepatitis.
Patients and methods : The case records of 387 patients with
hepatitis C and cirrhosis were studied. The prevalence and grade
of steatosis were investigated and evaluated by logistic regression
analysis as dependent variable to age, gender, alcohol consumption,
body mass index, hepatitis C virus (HCV) genotypes, liver
enzymes activity, histological activity index and fibrosis.
Results : Steatosis was found in 47.3% of the patients. It was
more prevalent in males, alcohol abusers, overweight and obese
patients, and in those with HCV genotypes 3 and 2. Multivariate
analysis confirmed body mass index as an independent risk factor
for steatosis in the overall patient cohort and in those with genotype1
without any correlation with the steatosis grade. The prevalence
and grade of steatosis were associated with alcohol consumption
and higher fibrosis stage. The age of the patients showed
converse association.
Conclusions : The male gender, body mass index, alcohol consumption,
genotype 2 and 3 were confirmed as risk factors for
hepatosteatosis. Older patients had a lesser steatosis grade.
The correlation of histological activity index and fibrosis scores
with the prevalence and higher grade of steatosis suggested a
possibility to worsen the course of hepatitis C and to accelerate
disease progression. [Product Details...] |
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Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver diseasePrice: €10,00 |
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| The correlation between biochemistry, imaging-studies and
histology is a matter of controversy in non-alcoholic fatty liver
disease (NAFLD) and the major pathophysiology of non-alcoholic
steatohepatitis (NASH) is still unknown. We aimed to perform
a comparative analysis between clinical, biochemical and histological
variables of NAFLD. One-hundred and five NAFLD
patients (F/M : 51/54), were studied, all with no-alcohol intake.
The groups were followed-up for six months.
Necroinflammation and fibrosis were more severe in patients
with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing
NAFL to NASH, plasma nitric-oxide and malondialdehyde
levels were significantly higher (p = 0.05, for-both), and vitamin-E
and-C levels were significantly lower in NASH (p = 0.002, and
0.001, respectively). The serum ferritin levels were higher in
NASH patients (p = 0.016). While the ultrasonographic grade was
significantly higher, the liver-spleen density gradient was significantly
lower in NASH group (p = 0.017, and 0.005, respectively).
Within a six month period, serum ALT levels dropped into the
normal range in 23/76 (30.3%) patients and serum ALT in the
6th month correlated significantly with the severity of steatosis,
inflammation and fibrosis in initial biopsy(p = 0.023, 0.035, 0.011,
respectively).
In conclusion, the probability of severe liver disease is higher in
patients with elevated-ALT in NAFLD. Serum ferritin levels have
some prognostic significance in liver damage and fibrosis. Overt
diabetes is predictive of advanced fibrosis and inflammation.
However impaired glucose-tolerance is not. The advice on diet and
exercise for six months after diagnosis may be a good strategy in
NAFLD. The patients with normal-ALT without hepatomegaly,
morbid-obesity and diabetes seem to have a good prognosis,
however some of these patients may still require liver biopsy. [Product Details...] |
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Expression of Bax protein in gastric carcinomas. A clinicopathological and immunohistochemical studyPrice: €10,00 |
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| Background and study aims : Reduced Bax protein expression
has been shown to be a negative prognostic factor in patients with
breast, ovarian, colorectal, esophageal and pancreatic cancer. Our
aim was to immunohistochemically study Bax protein expression
in gastric carcinomas and correlate its expression with clinicopathological
parameters and prognosis.
Patients and methods : Immunohistochemistry was performed,
using a monoclonal antibody against bax, in paraffin-embedded
tumor specimens from 47 cases of gastric cancer.
Results : Positive staining for the Bax protein was found in 20/47
(42.4%) adenocarcinomas examined. Negative Bax protein expression
in tumour cells was correlated with lymph node metastasis
(P < 0.05), and degree of differentiation (p<0.05). Univariate
analysis showed that the variables with a significant negative
impact on survival were : high TNM tumour stage, depth of
penetration in the gastric wall, lymph node involvement, and Bax
protein expression. Multivariate analysis showed that the only
variable with an impact on survival was Bax protein expression
(p<0.05, Relative Risk : 3.34). Kaplan-Meier curves showed that
the 5-year survival was 36.8% in cases with positive compared
with 16% in cases with negative Bax protein expression
(p=0.0427).
Conclusion : Negative Bax expression in gastric cancer is associated
with de-differentiation, lymph node metastases, and poor
clinical prognosis. Bax protein expression might play an important
role in the development and phenotypic differentiation of gastric
carcinomas and tumor progression. [Product Details...] |
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Insulin resistance and metabolic syndrome in patients with NAFLD but without diabetes : effect of a 6 month regime interventionPrice: €10,00 |
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| Background and study aims : Non-alcoholic fatty liver disease
(NAFLD) and the metabolic syndrome are two intertwined
diseases sharing the same factor in their pathogenesis ; insulin
resistance. The aim of the study was to establish a link between
glucose tolerance and NAFLD.
Patients and methods : Fifty-two non-diabetic NAFLD patients
were included in the study. Inclusion criteria were elevated alanine
aminotransferase (ALT), hyperechogenic liver detected at ultrasonography,
and exclusion of other causes of liver disease.
Hepatobiliary ultrasonography and laboratory tests including
biochemical and metabolic profiles were performed ; HOMA
insulin resistance was calculated.
Results : The mean age was 43 years, and 61% were male. More
than a two fold increase in alanine aminotransferase levels was
seen in 37% of the patients. Serum levels of aspartate aminotransferase,
gamma-glutamyl transferase, alkaline phosphatase (ALP)
were elevated in 36%, 46%, and 30% of patients respectively. Low
HDL-C levels were found in 46% and high LDL-C levels in 25%.
Other results of note were elevated lipoprotein-a levels in 40%,
impaired fasting glucose in 23%, impaired glucose tolerance in
26%, elevated fasting c-peptide levels in 61%, and elevated fasting
serum insulin levels in 11% of patients. In 30% of patients, body
mass index was over 30 kg/m2 and 78% had a waist-hip ratio
more than 0.9. HOMA insulin resistance was significantly related
with elevated ALP levels and hepatomegaly. Following a 6 months
treatment with a standard diet, liver enzymes and metabolic
parameters both improved. Only 7 patients had persistently high
liver enzymes.
Conclusions : Basal insulin levels and the oral glucose tolerance
test should be an integral part of the evaluation of patients with
NAFLD. The association between NAFLD and metabolic syndrome
as well as the benefits of dieting on preventing progression
of NAFLD should be stressed. [Product Details...] |
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Acta gastroenterologica is abstracted/indexed in Current Contents, Excerpta Medica, Index medicus, ISI.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.