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PubMedDate not supplied

[Combination of cancer markers in the detection and prognosis of digestive system tumors].

The role of carcinoembryonic antigen (CEA), gamma glutamyl transpeptidase (gamma GT), phosphohexose isomerase (PHI), pseudouridine (PSD) and acute phase reactant proteins (C-reactive protein (C-RP], alpha 1-acid glycoprotein (alpha 1-AGP) and alpha 1-antichymotrypsin (alpha 1-ACT) in distinguishing benign from malignant conditions of the digestive tract and their value in assessing the prognosis of gastrointestinal neoplasms was evaluated. For each marker it has been possible to produce a simple scoring index derived from the values found in the control population. This work suggests that pre-operative levels of certain cancer markers may be useful in tumor detection and may also give prognostic information additional to pathological staging.

Acute-Phase Proteins↗
PubMed1994

Echolaparoscopy: an indispensable procedure for laparoscopic surgery.

The widespread use of operative and diagnostic laparoscopy leads to growing use of laparoscopic ultrasound as a complementary procedure. A preliminary study was performed to evaluate the efficacy of laparoscopic ultrasound using a linear array laparoscopic probe characterised by double frequency, mechanical flexibility and availability of Doppler analysis. Twenty-five cases of cholecystolithiasis were evaluated during laparoscopic cholecystectomy in comparison with laparoscopic cholangiography: no differences were observed. Nine cases of gastrointestinal neoplasms (gastric, colon, pancreatic, and liver cancer) were evaluated in comparison with preoperative sonography and computed tomography. Laparoscopic sonography improves abdominal malignancy detection (cancer spread, lymph node metastasis, liver metastasis), thus modifying therapeutic decisions. The possibility of moving the probe in flexion extension movements allows a complete, multiplane exploration of operative fields. Laparoscopic sonography represents a complementary, indispensable diagnostic method during laparoscopic surgery.

Aged↗
PubMed2005

Gastrointestinal tumours in elderly.

The Authors report their experience concerning 129 cases of gastrointestinal neoplasms (gastric, colonic, anorectal), recorded during the last years among patients aged between 70 and 81 years, who underwent radical surgery. The main issues evaluated were: anaesthesiological risk, stage, post-operative mortality and morbidity. Elderly seems not to be a contraindication, nor a limit for surgery if the patient is correctly and strictly managed pre and post-operatively.

Aged↗
PubMed1987

Laser therapy in gastrointestinal practice.

Use of the Nd:YAG laser in therapeutic endoscopy has caught the imagination of many physicians. Understanding the principles of laser physics to apply laser techniques correctly is not difficult. Currently, the laser is used for control of gastrointestinal hemorrhage and for debulking obstructing tumors in the upper and lower gastrointestinal tract. Hemostasis has been achieved in 70-100% of patients with a variety of bleeding lesions. Specific laser techniques vary in the power used and exposure time, but some standardization has been agreed on. Obstructing gastrointestinal neoplasms may now be safely and effectively ablated to achieve patency of the lumen. Perforation from laser therapy occurs in 1% or less of patients treated, making this a reasonably safe form of treatment. The high cost of laser unit (approximately $85,000) and the availability of equally effective and more reasonably priced alternatives require careful attention to the cost-effectiveness of the laser. Training physicians in the safe use of lasers is a problem that still must be solved by the users and instrument makers.

Endoscopy↗
PubMed2000

Gastrointestinal stromal tumors treated by laparoscopic surgery: report of three cases.

Three cases of gastrointestinal stromal tumors (GIST) were treated by a laparoscopic wedge resection of the stomach. The tumor characteristics were confirmed to be nonepithelial, nonlymphomatous, nonmyogenic, and nonneurogenic gastrointestinal neoplasms with an uncertain origin which were CD34-positive and actin- and S-100-negative. The malignant potential was estimated based on the mitotic figures and growth rates. The results suggest that laparoscopic surgery is an adequate strategy for gastric submucosal tumors including GIST, and also indicates this technique to be a curative, safe, and minimally invasive procedure for both diagnosis and treatment.

Actins↗
PubMedDate not supplied

Dynamics of diurnal changes in serum concentration of TNF-alpha soluble receptors in gastrointestinal cancer patients.

The objective of the study was to investigate the dynamic changes in soluble TNFalpha p-55 and p-75 receptors in serum of advanced cancer patients during 24 hours. The group examined consisted of 42 patients suffering from advanced gastrointestinal neoplasms (colorectal, gastric and pancreatic cancer). Serum levels of the cytokine and both receptors in cancer patients were measured using ELISA type kits 6 times a day (8.00 a.m., 2.00 p.m., 6.00 p.m., 10.00 p.m., 2.00 a.m. and again 8.00 a.m.) as well as in healthy controls. The levels of TNFalpha and its soluble receptors were substantially increased in the examined group and displayed statistically significant circadian fluctuations. The presence of circadian rhythm of the cytokine was proved (acrophase - 00.36 a.m.), however no diurnal rhythm of soluble TNF receptors was observed. The concentration of p-55 receptor was distinctly lower then p-75. The peak p-55 value appeared at 10.00 p.m. while the p-75 reached its minimum level at the same time. Although there was no statistical correlation between the receptor concentrations the shapes of both curves remained inversely proportional. The present results may suggest the presence of complex self-regulation mechanisms in advanced gastrointestinal cancer patients.

Adult↗
PubMed1981

Nonhematopoietic gastrointestinal neoplasia in cats: a retrospective study of 44 cases.

Gastrointestinal neoplasms other than lymphosarcomas and mast cell tumors were diagnosed in 44 cats during a 14-year period at the Washington Animal Disease Diagnostic Laboratory. All the tumors were malignant; 31 metastasized or recurred. One cat had fibrosarcoma; another, leiomyosarcoma. The other 42 cats had adenocarcinomas, which were subclassified into three histologic patterns: tubular adenocarcinoma; undifferentiated carcinoma; and mucinous adenocarcinoma. The cats averaged 10.6 years of age. There was no sex predisposition. Siamese cats had a higher frequency of adenocarcinomas than other breeds. Osseous and chondroid metaplasia occurred in nine adenocarcinomas.

Adenocarcinoma↗
PubMedDate not supplied

Histopathological features and clinical course of the gastrointestinal stromal tumors.

BACKGROUND/AIMS: C-kit expression is a sensitive marker for a specific group of mesenchymal tumors of the gastrointestinal tract, gastrointestinal stromal tumors, the histogenesis and prognosis of which are uncertain. METHODOLOGY: We have investigated the expression of c-kit by immunohistochemical analysis (APAAP method) in 12 out of 13 cases of mesenchymal gastrointestinal neoplasms operated from January 1991 to December 1998, in which the follow-up data were fully available. Furthermore, the c-kit expression was correlated both with the expression of vimentin, CD34 and the mitotic rate, and with the expression of muscle (muscle-specific actin-HHF35 and desmin) or neural (neuron-specific enolase) differentiation markers. RESULTS: C-kit was expressed in all 12 cases (100%). Two different patterns of expression were observed: cytoplasmic in 7 (58.3%) cases and nuclear in 3 (25%) cases; in 2 (16.7%) cases both cytoplasmic and nuclear immunostaining was detected. Three (60%) out of the five cases showing a nuclear c-kit expression were also neuron-specific enolase positive, whereas none of the cases showing an exclusively cytoplasmic c-kit expression was neuron-specific enolase positive. The correlation between the two patterns of c-kit expression and the follow-up data have shown a trend towards a better prognosis in gastrointestinal stromal tumors with a nuclear c-kit immunostaining and neuron-specific enolase positivity, but the relatively low number of cases does not allow us to draw conclusions. In gastrointestinal stromal tumors the mitotic rate (> 2 x 10 HPF vs. < 2 x 10 HPF) is related with statistically significant differences (P < 0.05) to the 5-year survival (0% vs. 80%, respectively). CONCLUSIONS: These findings, together with the already known c-kit nuclear immunostaining in normal adrenal medullary cells, suggest that a nuclear c-kit expression in gastrointestinal stromal tumors is consistent with a neural differentiation. In this study the mitotic rate has demonstrated a significant influence on the prognosis of gastrointestinal stromal tumors.

Adult↗
PubMed1995

Death from Crohn's disease. Lessons from a personal experience.

We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term "virulent" Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25-46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.

Adolescent↗
PubMed2001

Review of harmful gastrointestinal effects of carrageenan in animal experiments.

In this article I review the association between exposure to carrageenan and the occurrence of colonic ulcerations and gastrointestinal neoplasms in animal models. Although the International Agency for Research on Cancer in 1982 identified sufficient evidence for the carcinogenicity of degraded carrageenan in animals to regard it as posing a carcinogenic risk to humans, carrageenan is still used widely as a thickener, stabilizer, and texturizer in a variety of processed foods prevalent in the Western diet. I reviewed experimental data pertaining to carrageenan's effects with particular attention to the occurrence of ulcerations and neoplasms in association with exposure to carrageenan. In addition, I reviewed from established sources mechanisms for production of degraded carrageenan from undegraded or native carrageenan and data with regard to carrageenan intake. Review of these data demonstrated that exposure to undegraded as well as to degraded carrageenan was associated with the occurrence of intestinal ulcerations and neoplasms. This association may be attributed to contamination of undegraded carrageenan by components of low molecular weight, spontaneous metabolism of undegraded carrageenan by acid hydrolysis under conditions of normal digestion, or the interactions with intestinal bacteria. Although in 1972, the U.S. Food and Drug Administration considered restricting dietary carrageenan to an average molecular weight > 100,000, this resolution did not prevail, and no subsequent regulation has restricted use. Because of the acknowledged carcinogenic properties of degraded carrageenan in animal models and the cancer-promoting effects of undegraded carrageenan in experimental models, the widespread use of carrageenan in the Western diet should be reconsidered.

Animals↗
PubMed2006

Capecitabine plus weekly oxaliplatin in gastrointestinal tumors: a phase I study.

OBJECTIVE: To investigate the maximum tolerated dose (MTD) and the dose-limiting toxicity (DLT) of capecitabine plus oxaliplatin. MATERIALS AND METHODS: Oxaliplatin was given by 2-hour iv infusion on days 1 and 8, and capecitabine was given orally, from day 1 to 14, every 3 weeks. We tested 4 levels of doses: 1) capecitabine 1650 mg/m2 + oxaliplatin 50 mg/m2; 2) capecitabine 2000 mg/m2 + oxaliplatin 50 mg/m2; 3) capecitabine 2000 mg/m2 + oxaliplatin 60 mg/m2; and 4) capecitabine 2500 mg/m2 + oxaliplatin 60 mg/m2. Patients with gastrointestinal neoplasm were eligible for the study. RESULTS: Thirty-two patients were enrolled. At dose level 4, 3 patients had unacceptable toxicity (grade 3 diarrhea, grade 4 diarrhea, and grade 3 mucositis, respectively), thus, level 4 was the MTD. Apart from DLT, overall toxicity was mild: grade > or =3 nonhematological toxicity occurred in 3 patients, and hematological toxicity was sporadic. CONCLUSION: This study demonstrates that clinically relevant doses of capecitabine (2000 mg/m2 from day 1 to 14) plus oxaliplatin (60 mg/m2 on days 1 and 8) every 3 weeks can be given without causing unacceptable toxicity.

Administration, Oral↗
PubMed1984

Metabolic studies of delta-9-tetrahydrocannabinol in cancer patients.

The metabolism of oral delta-9-tetrahydrocannabinol (THC) was studied in nine patients with gastrointestinal neoplasms receiving chemotherapy regimens containing 5-FU and semustine. Plasma levels of THC and its metabolites 11-OH-delta-9-THC (11-OH-THC) and 11-nor-9-carboxy-delta-9-THC (C-THC) were measured. Plasma levels of THC and its metabolites were quite variable among the patients studied. Plasma levels of THC and 11-OH-THC tended to peak at the same time; the C-THC levels peaked later and lasted much longer than the others. Mean half-lives of THC, 11-OH-THC, and C-THC were estimated to be 1.5, 2.1, and 4.4 hours, respectively. Multiple doses of THC did not produce a significant additive effect on the plasma concentrations of the biologically active metabolites THC and 11-OH-THC. No correlation between antiemetic effect or cannabinoid toxicity and plasma levels of the three metabolites could be made in this small number of patients.

Adult↗
PubMed1983

Multivariate analyses as aids to diagnosis and assessment of prognosis in gastrointestinal cancer.

The role of carcinoembryonic antigen (CEA), gamma glutamyl transpeptidase (gamma GT), phosphohexose isomerase (PHI), pseudouridine (psi) and acute phase reactant proteins (C-reactive protein (CRP) alpha 1-antichymotrypsin (ACT) and alpha 1-acid glycoprotein (AGP] in assessing the prognosis of gastrointestinal neoplasms and the discriminant function in distinguishing benign from malignant diseases of the GI tract was examined. In stomach cancer pre-operative levels of CRP can help in the identification of the patients with a resectable tumour; the pre-operative biochemical measurements do not give any further information on prognosis once stage and site are taken into account. In colorectal cancer pre-operative ACT levels give additional prognostic information once the clinical factors, Dukes stage, sex and age have been accounted for; PHI levels are on the border line of significance. A discriminant function has been devised using sex, CEA, psi, gamma GT, ACT and PHI that can identify 89% of Dukes "D" patients prior to surgery with a misclassification of 7% of other cases of colorectal cancer. A discriminant function using all the biochemical variates separated the cancer from non-cancer patients. The false positive rate for cancer was 16% and a false negative rate of 19%, when the cut-off level was set at 0.7.

Adult↗
PubMed1987

Gastrointestinal lymphoma and sarcoma. A case for aggressive search and destroy.

The incidence of sarcomas of the gastrointestinal tract has remained the same, but gastrointestinal lymphomas are gradually contributing a larger percentage of malignant gastrointestinal neoplasms. The authors have examined their more recent experience with these relatively rare lesions. Twenty-eight patients (13 with lymphoma, 15 with sarcoma) have been treated at the Vanderbilt University and the Metropolitan Nashville General Hospital since 1976. There were eight men in the group with lymphoma and six in the group with sarcoma. The average age for patients with lymphoma was 66 years; the average age was 57 years in the patients with sarcoma. Seven patients with lymphoma and eight patients with sarcoma had been treated for 6 months to 3 years for presumed peptic ulcer disease. Eight of these 15 patients were found to have perforated tumors at the time of surgical exploration. Three patients (all in the group with sarcoma) had metastatic liver disease or peritoneal implants at the time of diagnosis. Treatment for most patients included resection of the tumor, followed by chemotherapy or radiation in cases of tumor perforation or metastatic disease. The survival rate for patients with lymphoma has averaged 5.5 years, with a 55% 5-year survival rate. Patients with cleaved cell tumors survived longer than those with other types of lymphoma. In the group with sarcoma, the survival rate has been 3.1 years on the average, with a 21% 5-year survival rate.

Aged↗
PubMedDate not supplied

Influence of preoperative intravenous nutrition upon hepatic protein synthesis and plasma proteins and amino acids.

The influence of 3 and 7 days of preoperative intravenous nutrition (IVN) on the capacity for protein synthesis in liver and on concentrations of plasma proteins and amino acids were investigated in patients with gastrointestinal malignancy. Thirty patients with gastrointestinal neoplasms who had lost more than 5 kg of weight over 3 months were randomized into three groups to receive preoperatively: (a) no IVN, (b) IVN for 3 days (0.18 gN/kg/day as amino acid; 30 kcal/kg/day as glucose), or (c) IVN for 7 days. Free access to a hospital diet was available to all patients including 10 patients who had not lost weight who served as controls. In the three groups of patients who had lost weight, median transferrin and fibronectin were lower than for controls, whereas other proteins and amino acids were comparable. After feeding, samples of liver were obtained peroperatively and the potential rates of protein synthesis were calculated from the in vitro incorporation of (14C)-leucine, into protein. Preoperative IVN significantly increased the potential rate of protein synthesis in liver after 3 days. Plasma amino acids were comparable with controls whereas in the unfed-group concentrations suggested utilization of alanine and breakdown of muscle. Three days of IVN also increased plasma fibronectin and IgA but increases of prealbumin, IgM, and complement C3 were only significant in the group fed for 7 days. On the 7th postoperative day plasma proteins were decreased similarly in each group. This study shows that concentrations of several plasma proteins, in preoperative patients reflect net rates of hepatic protein synthesis and are susceptible to depletion during starvation and repletion by 3 or 7 days of IVN.

Aged↗
PubMed1975

Tumors of the small intestine.

An analysis of 80 cases of malignant and benign tumors of the small intestine is presented, and major clinical features of various histologic lesions are discussed. Tumors of the small intestine are rare, and the small bowel may have intrinsic protective systems against the development of neoplasms. Gastrointestinal bleeding and symptoms of intermittent obstruction are prominent findings in patients with symptomatic benign tumors, although many benign tumors are incidental findings at operation for an unrelated disease. Benign lesions should be removed by local excision. Virtually all malignant tumors are symptomatic with abdominal pain, nausea and vomiting, anorexia and weight loss, and gastrointestinal bleeding being common findings. Earlier diagnosis is essential if the prognosis for patients with small intestinal malignancies is to be improved. A high degree of suspicion must be aroused with any vague, nonspecific gastrointestinal complaints in patients over 40 years of age. Exploratory celiotomy should be performed in symptomatic patients even though no abnormality may be detected on roentgenographic examination.

Adenocarcinoma↗