Yoshiyuki Nishikawa

Circulating vascular endothelial growth factor (VEGF) is a possible tumor marker for metastasis in human hepatocellular carcinoma

Abstract: Vascular endothelial growth factor (VEGF) is closely related to angiogenesis in various human cancers. However, little is known of its circulating levels in hepatocellular carcinoma (HCC). We examined circulating VEGF levels in chronic liver disease to assess their clinical significance. Plasma VEGF concentrations were determined, by enzyme immunoassay, in patients with chronic hepatitis (CH; n = 36), liver cirrhosis (LC; n = 77), and HCC (n = 86) for a cross-sectional study. Plasma VEGF levels in healthy controls (n = 20) and CH, LC, and HCC patients were 17.7 ± 5.4 (mean ± SD), 30.6 ± 22.8, 34.4 ± 27.0, and 51.1 ± 71.9 pg/ml, respectively. The levels were significantly elevated in the HCC group, compared with the control, CH, and LC groups. Plasma VEGF levels in stage I, II, III, IVA, and IVB HCC patients were 27.6 ± 16.1, 26.5 ± 13.7, 35.8 ± 15.3, 45.4 ± 39.4, and 103.1 ± 123.2 pg/ml, respectively. The stage IVB patients with remote metastasis showed significantly marked elevation compared with the patients at the other stages. Platelet numbers were weakly correlated with plasma VEGF levels in the HCC group. Plasma VEGF level was highly elevated in patients with HCC, particularly those with metastatic disease. We consider that plasma VEGF is a possible tumor marker for metastasis of HCC. Circulating VEGF may be derived mainly from the large burden of tumor cells, and partly from platelets activated by the vascular invasion of HCC cells.

Simultaneous combination of endoscopic sclerotherapy and endoscopic ligation for esophageal varices

Endoscopic injection sclerotherapy (EIS) is an established standard t reatment for esophageal varices 1, 2; however, EIS entails complicated manipulation. Endoscopic variceal ligation (EVL) ~-5 has been increasingly performed because of the safety and simplicity of the technique because no sclerosant is used. To accomplish rapid eradication of the varices and prevent recurrence, a technique that combines EVL and EIS has also been performed. 6, 7 For more effective and simple EIS, we developed a method that simultaneously combines EVL and EIS (endoscopic injection sclerotherapy with ligation: EISL). EIS was performed after application of the EVL device, and EVL was performed (including the injection site) immediately after infusion of the sc]erosant. This technique may be more effective because of better sclerosant effect after interruption of blood flow s and the absence of bleeding after removal of the needle.

Evaluation of endoscopic injection sclerotherapy with and without simultaneous ligation for the treatment of esophageal varices.

Abstract: For more effective and simple endoscopic injection sclerotherapy (EIS) for esophageal varices, we developed an EIS procedure with ligation (EISL) that is non-invasive, in which EIS and endoscopic variceal ligation (EVL) are performed simultaneously. In this study, we compared EISL and EIS in a randomlized sample of patients (n = 14 for each procedure). For EISL, EVL was performed, including the injection site, after the injection of 5% ethanolamine oleate with iopamidol (EOI) into a varix. The mean number of treatment sessions required for eradication of esophageal varices was 2.3 ± 0.5 for EISL and 3.9 ± 0.8 for EIS (P < 0.001); the mean number of treatment sites was 6.2 ± 2.2 for EISL and 14.0 ± 5.0 for EIS (P < 0.001); the mean total amount of EOI used was 13.8 ± 5.2 ml for EISL and 26.3 ± 9.8 ml for EIS (P < 0.001). There were no significant differences in rates of recurrence of varices or in bleeding between the two groups. For EISL, fewer treatment sessions and less sclerosant were sufficient, probably because the sclerosants were more effective due to the blockage of variceal blood flow by the ligation. This method should provide a novel modification of EIS.

Analysis of anxiety in cancer patients: The effects of telling the truth

BackgroundThe mental distress suffered by cancer patients after telling them the truth about their diagnosis, is one of the main reasons why disclosure of cancer is not becoming more common in Japan. Using the State-Trait Anxiety Inventory (STAI), a self-rating scale, we assessed the anxiety level among cancer patients given information about their disease.MethodsOne hundred and sixty-one patients were solicited for participation in this study and complete answers to the Inventory were obtained from 118 patients. The STAI was administered twice, on the day of admission and after a precise explanation of the patients disease, and was later compared. The information the patients had been given about their disease prior to admission, and the later explanations from the 8 attending physicians, given at the time of informed consent to treatment, were reviewed. The patients were divided into the following 4 groups according to the explanations given by the doctors; (1) 32 patients needed treatment for benign diseases, (2) 18 patients (all had cancers of digestive organs) were told euphemistically that they had tumors that required treatment, (3) 23 patients were newly diagnosed with cancer after admission, and (4) 41 patients had the same diagnosis of cancer as they had before admission. The remaining 4 patients were excluded because of an incorrect diagnosis.ResultsMany patients showed high State (43–72%) and Trait (21–46%) anxiety levels on admission. There was, however, no difference in the STAI scores between the 4 groups. The State anxiety scores in most of the patients with benign diseases were reduced to the normal range after explanation. Scores for those patients told euphemistically about their condition were also decreased significantly after admission, but their overall anxiety levels were still high. The patients diagnosed with cancer before admission and those newly diagnosed showed no significant changes in their STAI scores.ConclusionAnxiety remains high in cancer patients after clear or even euphemistic disclosure of cancer. This study demonstrated that giving patients an ambiguous explanation about their disease did not bring about additional emotional stability, and the anxiety already present did not get worse, even when the diagnosis was changed from tumors with the possibility of cancer to definite cancer.

Classification of atrophic mucosal patterns on Blue LASER Imaging for endoscopic diagnosis of Helicobacter pylori-related gastritis: A retrospective, observational study

Background Atrophic gastritis can be classified according to characteristic mucosal patterns observed by Blue LASER Imaging (BLI) in a medium-range to distant view. Aims To facilitate the endoscopic diagnosis of Helicobacter pylori (HP)-related gastritis, we investigated whether atrophic mucosal patterns correlated with HP infection based on the image interpretations of three endoscopists blinded to clinical features. Methods This study included 441 patients diagnosed as having atrophic gastritis by upper gastrointestinal endoscopy at Nishikawa Gastrointestinal Clinic between April 1, 2015 and March 31, 2016. The presence/absence of HP infection was not taken into consideration. Endoscopy was performed using a Fujifilm EG-L580NW scope. Atrophic mucosal patterns observed by BLI were classified into Spotty, Cracked and Mottled. Image interpretation results were that 89, 122 and 228 patients had the Spotty, Cracked and Mottled patterns, respectively, and 2 patients an undetermined pattern. Further analyses were performed on 439 patients, excluding the 2 with undetermined patterns. Results The numbers of patients testing negative/positive for HP infection in the Spotty, Cracked and Mottled pattern groups were 12/77, 105/17, and 138/90, respectively. The specificity, positive predictive value and positive likelihood ratio for endoscopic diagnosis with positive HP infection based on the Spotty pattern were 95.3%, 86.5% and 8.9, respectively. In all patients with the Spotty pattern before HP eradication, the Cracked pattern was observed on subsequent post-eradication endoscopy. Conclusions The Spotty pattern may represent the presence of HP infection, the Cracked pattern, a post-inflammatory change as seen after HP eradication, and the Mottled pattern, intestinal metaplasia.

3551 Evaluation of the multiple band ligator in endoscopic injection sclerotherapy with simultaneous ligation for treatment of esophageal varices.

Background:We developed endoscopic injection sclerotherapy with ligation (EISL), which involves EVL of the area including the injection site immediately after injection of the sclerosant into varices, and have used this method since 1993. The usefulness of this method has been documented in our previous reports, but the pneumatic EVL device with a channel for puncture needle, which is commercially available only in Japan, has been required for the method. Recently, a multiple band ligator, with which insertion of puncture needles is possible, has become available internationally. Therefore, we examined the usefulness of the multiple band ligator. Method: The EVL device used was the Injection Speedband Superview(8-band ligator). EISL was performed by the following procedures. A balloon inserted with the EVL device was inflated, EOI was injected into a varix using a needle, and EVL was performed in the area including the injection site, while the needle was kept in place in the varix. The balloon was kept in an inflated state up to the end of operation. The subjects were patients with esophageal varices who were classified as being an F2 (enlarged tortuous varices) red color sign (+1) or more advanced stages, with and without bleeding. Results: Sixteen EISL sessions were performed on 9 patients. The mean EISL session per patient was 1.9±0.3 in this study, while it was 2.1±0.7 in 99 patients who were treated by EISL using the single-band EVL device. The mean time per EISL session was 9.3±2.1 min in this study, which was significantly shorter than that in the 99 patients treated with the single-band EVL device (11.5±3.4). The number of O-ring used per session was 7 at the maximum and 2.8 on average. Therefore, the 8-band ligator was sufficient for treatment. None of the patients had complications. Conclusions: The device used in this study, Injection Speedband Superview, gave visual fields sufficient for the EIS procedure while the device was inserted. The session time was shortened because the procedure can be continuously performed. Furthermore, because the inserted balloon can be kept inflated up to the end of the procedure, outflow of EOI via other varices due to deflation could be prevented. Therefore, this device was proved to be ideal for EISL.