Gastric metastasis from ovarian carcinoma: A case report and literature review

An isolated parenchymal gastric metastasis from ovarian carcinoma without any other sites of recurrence is extremely rare. Only two cases have been reported, both of which were symptomatic. We herein report such a case without any symptoms. A 61-year-old woman presented with a high cancer antigen-125 level without any other clinical manifestation. A subsequent ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography scan revealed a submucosal mass with hypermetabolism of ¹⁸F-FDG (standardized uptake value: 5.36) in the gastric antrum. The final pathology after gastric antrectomy showed a metastatic gastric tumor from a primary ovarian carcinoma. We also performed an extensive literature review about gastric metastasis from ovarian carcinoma published until recently, and this is the first case of an isolated parenchymal gastric metastasis from ovarian carcinoma without any symptoms.     

Ulcer in the gastric tube for esophageal replacement: a comparison of 12 esophageal cancer patients with or without postoperative radiotherapy

BACKGROUND AND AIMS: Ulcer in the gastric tube for esophageal replacement, which was caused by peptic factors or postoperative radiotherapy (Rx), are occasionally reported. The aim of this study was to clarify the clinicopathologic features of the ulcers in the gastric tube. METHODS: In 62 patients with a reconstructed gastric tube, after esophagectomy for esophageal cancer, esophagogastroduodenoscopy was performed. Ulcers of the gastric tube were detected in 12 patients: six with postoperative Rx and six without Rx. The 12 patients with gastric tube ulcers (GU-group) were reviewed and compared to the remaining 50 patients without ulcers of the gastric tube (Control-group). Clinicopathologic features of gastric tube ulcers were compared between the patients with and without Rx. RESULTS: There was no difference in any parameter between the patients of the GU- and Control-groups. Comparing the patients of the GU-group with and without Rx, the ulcers of the gastric tube in the patients without Rx were frequently located in the lower part of the gastric tube (P = 0.067), detected in a later period after surgery (P = 0.055), associated with cervical esophagitis (P = 0.03), and less associated with gastritis (P = 0.03). In three patients of the GU-group without Rx, Helicobacter pylori was detected in the gastric tube. Two of the three patients had a history of peptic ulcers before surgery, and had recurrence of the gastric tube ulcers. CONCLUSIONS: Gastric tube ulcers without postoperative Rx may have different characteristics compared to those induced by Rx.     

Delayed gastric emptying in anorexia nervosa is improved by completion of a renutrition program

The effects of renutrition on gastric emptying and upper gastrointestinal symptoms were evaluated in 14 anorexia nervosa patients before and after weight gain. A double-isotope technique was used to measure gastric emptying of both the solid and the liquid phases of the meal. Upper gastrointestinal symptoms were frequent before renutrition, occurring in 78% of the patients. Among these symptoms, nausea, vomiting and gastric fullness were correlated well with slowing in gastric emptying of both solid and liquid phases of the meal, which was demonstrated, respectively, in 10 (71%) and nine (64%) of the 14 patients. For the 11 patients who subsequently gained body weight, we observed, without any pharmacological treatment, an improvement of gastric emptying of both solid and liquid phases of the meal in eight (73%) and seven (64%) patients, respectively. Gastric emptying was unchanged in the three other patients who gained very little weight during the time of the study. As gastric emptying improved, so did nausea, vomiting, and gastric fullness. In three patients who had initially gained weight, nausea and gastric fullness recurred, associated again in all cases with a delay in gastric emptying. In conclusion, in anorexia nervosa, delayed gastric emptying, which is a frequent feature and which is well correlated with some of the upper digestive complaints, can return to normal without any pharmacological treatment. In this improvement, psychological assistance may play a role, together with the correction of the malnutrition.     

Protective Action of Deglycyrrhizinized Liquorice on the Occurrence of Stomach Ulcers in Pylorus-Ligated Rats

The effect of graded doses of a deglycyrrhizinized liquorice extract (d.Li.) was studied on the frequency of stomach ulcers and the secretion of gastric juice in pylorus-ligated rats. 25-50 mg of d.Li. given intraperitoneally reduced considerably the number of ulcers in comparison with the control group of rats without any significant changes in gastric secretion. Higher doses —100-200 mg — gave complete protection against the development of gastric ulcers and also reduced the output of gastric juice. The results give strong support for the existence of an ulcer-protecting principle in the d.Li.     

Ectopic gastric mucosa of the gallbladder: comparison with metaplastic polyp of the gallbladder

We report a case of ectopic gastric mucosa of the gallbladder in a 44-yr-old man. A sessile polypoid lesion 1.0 cm in diameter was seen in the body of the gallbladder, without gallstones. The polypoid lesion consisted of gastric pyloric glands and fundic glands. The surrounding mucosa consisted of ordinary gallbladder epithelium without any metaplastic change. To elucidate the characteristics of this lesion, a clinicopathological comparison was made with metaplastic polyp of the gallbladder.     

胃癌细胞中环氧合酶-2对延迟整流性钾通道调控机制的研究

目的 探讨胃癌细胞中环氧合酶(COX)-2对延迟整流性钾通道(HERG)电流的影响和相应的调控机制.方法 ①采用逆转录聚合酶链反应(PCR)、Western印迹和膜片钳技术检测环氧合酶(COX)-2反义载体转染胃癌细胞前后HERG mRNA、蛋白和电流的变化.②采用酶联免疫吸附试验检测COX-2反义载体转染胃癌细胞前后环磷酸腺苷(cAMP)水平的变化.③采用PCR技术构建缺失cAMP结合结构域的HERG突变体,并转染胃癌细胞.④应用COX-2抑制剂和前列腺素(PG)E2作用于胃癌细胞和HERG突变体转染的胃癌细胞,观察HERG电流的变化.⑤将cAMP的拟似剂和拮抗剂、蛋白激酶(PK)A抑制剂分别作用于胃癌细胞和HERG突变体转染的胃癌细胞,观察相应的HERG电流变化.结果 ①与亲本细胞相比,COX-2反义转染胃癌细胞的HERG mRNA和蛋白表达无变化,而HERG电流强度减弱(P<0.05).②与亲本细胞相比,COX-2反义转染胃癌细胞中的cAMP水平明显下降(P<0.05).③COX-2抑制剂减弱而PGE2增强HERG电流的强度.但在缺失cAMP结合域的HERG突变体转染后的胃癌细胞,COX-2抑制剂和PGE2对HERG电流未产生明显的影响.④cAMP拟似剂可增强SGC7901细胞的HERG电流,而cAMP拮抗剂则减弱其电流.但对于缺失cAMP结合结构域的突变体转染的胃癌细胞中的HERG电流,cAMP的拟似剂和拮抗剂均未显示出明显的增强或抑制作用.⑤PKA抑制剂对SGC7901细胞和突变体转染的胃癌细胞的HERG电流均无明显影响.结论 COX-2通过其代谢产物PGE2而影响HERG电流.PGE2通过与受体结合后影响cAMP浓度,而cAMP通过与HERG蛋白上的特殊结构域结合对HERG电流产生影响,此过程不受PKA的调控.     

Role of submandibular saliva and epidermal growth factor in gastric cytoprotection

The role of submandibular epidermal growth factor in protection of the gastric mucosa was investigated in rats. Removal of the submandibular glands and thereby submandibular epidermal growth factor (EGF) caused rats to develop gastric lesions (ulcerations and ulcers) after administration of the duodenal ulcerogen cysteamine. The median output of EGF in gastric juice was reduced from 45.6 pmol/12 h (total range 17.5-65.0) in unoperated controls to less than 0.06 pmol/12 h (total range less than 0.06-1.82) in rats given cysteamine after extirpation of the submandibular glands. The contents of EGF in the submandibular glands was unchanged during cysteamine treatment. Furthermore, the effects of intragastric instillation of exogenous EGF, infusion of saliva without EGF, and infusion of saliva with a high concentration of EGF on the development of cysteamine-induced gastric lesions were investigated in rats without submandibular glands. Exogenous EGF and saliva with a high but still physiological concentration of EGF significantly reduced the median area in the stomach displaying ulcers and ulcerations, whereas saliva without EGF had no effect. Although EGF is a known inhibitor of gastric acid secretion, the dose used in the present study had no effect on gastric acid secretion in chronic gastric fistula rats; removal of the submandibular glands also did not have any such effect. We conclude that exocrine secretion of submandibular EGF has a cytoprotective function in the stomach, an effect that may be physiological.     

Effects of omeprazole, a substituted benzimidazole, on gastrointestinal secretions, serum gastrin, and gastric mucosal blood flow in dogs

In dogs with gastric fistulas and vagally denervated Heidenhain pouches, omeprazole, a benzimidazole derivative infused intravenously or given intraduodenally, dose-dependently inhibited gastric acid secretion, which had been induced by histamine, pentagastrin, or urecholine. It also suppressed gastric acid response to physiologic stimulants such as sham-feeding and gastric peptone meal without affecting serum gastrin level. The inhibition of histamine-induced acid secretion was accompanied by a parallel reduction in the mucosal blood flow, but no significant alteration in the ratio (R) value, indicating that omeprazole primarily affected gastric acid secretion but did not limit gastric mucosal microcirculation. Omeprazole, infused into the Heidenhain pouch, caused a dose-dependent inhibition of the Heidenhain pouch response to intravenous histamine without any significant change in the acid response of the main stomach and plasma concentrations of the drug. This indicates that omeprazole may exhibit local inhibitory action on the oxyntic glands. Omeprazole did not affect gastric mucosal integrity or the rate of alkaline secretion from the gastroduodenal mucosa or the pancreas stimulated by duodenal acidification or secretin.     

Endoscopic retrieval of multiple fragmented gastric bamboo chopsticks by using a flexible overtube

This is a rare case of a patient with mental disorder, who ingested nineteen pieces of fragmented bamboo chopsticks. We managed the multiple gastric foreign bodies with a sclerotherapy overtube, and these multiple fragmented bamboo chopsticks were retrieved successfully using the endoscopic method. There were only multiple erosions with hemorrhage over the mucosa of fundus and body of stomach, no fragments adhered or perforated through the gastric wall. The mucosa of esophagus was intact. The patient tolerated the procedure well and without any major complications. Multiple sharp elongated gastric foreign bodies can be successfully and safely retrieved by using protective sheath of oropharynx without assistance with laparoscopy or surgical intervention. This renders an option for the endoscopists to manage multiple elongated gastric foreign bodies.     

Remission of primary low-grade gastric lymphomas of the mucosa-associated lymphoid tissue type in immunocompromised pediatric patients

We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue (MALT) type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unknown cause, complained of repeated abdominal pain. Examinations revealed gastric MALT with local invasion and lymph node involvement. Serum anti-Helicobacter pylori (H pylori) antibody was positive. H pylori eradication was abandoned due to its adverse effects. The MALT lesion spontaneously regressed over the next 24 months without any treatment for lymphoma. Patient 2, a 6-year-old boy,underwent cord blood transplantation for the treatment of adrenoleukodystrophy. He was administered immunosuppressants for graft-versus-host disease after transplantation. Nausea and hematochezia appeared and further examinations revealed gastric MALT with H pylori gastritis. Treatment consisting of medication for the H pylori infection alone eradicated the H pylori and completely resolved the patient's MALT lesion, as well. Patients 1 and 2 were followed up over periods of 10 years and 3 years, respectively, without any signs of relapse. In conclusion, gastric lymphoma of the MALT type can be cured by conservative treatment even in immunocompromised pediatric patients.     

Peptic ulcer and non-steroidal anti-inflammatory agents.

Aspirin is generally regarded as a cause of gastric ulcer but the role of non-steroidal anti-inflammatory agents and paracetamol in the aetiology of peptic ulcer is unclear. To investigate this we conducted a case control study of 180 matched pairs of peptic ulcer patients and controls obtained from surgical and dermatology outpatient clinics. There were 95 gastric ulcer and 85 duodenal ulcer patients. A statistically and clinically association (relative risk = 5) was found between the regular use of non-steroidal anti-inflammatory agents and gastric ulcer. There was also evidence of positive associations between gastric ulcer and aspirin containing preparations with or without non-steroidal anti-inflammatory agents. By contrast, duodenal ulcer was unrelated to these drugs. Too few patients used paracetamol for any conclusion to be drawn on its role.     

Effect of 16, 16-dimethyl PGE2 on resting and histamine-stimulated gastric mucosal blood flow

Using [¹⁴C]aminopyrine clearance as a measure of mucosal blood flow, 16, 16-dimethyl PGE₂ was administered orally as a single bolus and its effects on resting and histamine-stimulated gastric mucosal blood flow assessed in conscious dogs with vagally denervated gastric pouches. No effect on resting mucosal flow was observed with any of the doses (ie, 2, 10, and 50 g/kg) of prostaglandin given. In histamine-stimulated experiments, intravenous infusion of histamine dihydrochloride (1 mg/hr) elicited a significant (P<0.0005) increase from basal in gastric acid production, volume output, and gastric mucosal blood flow which remained unchanged for the duration of the study. Prostaglandin (50 g/kg) significantly decreased (P<0.0005) these secretory responses and markedly inhibited (P<0.005) muscosal blood flow without altering the ratio (R) of flow to the volume rate of secretion. The observation that R was unchanged suggests that this inhibitory action of 16,16-dimethyl PGE₂ on gastric secretion and blood flow was mediated through direct effects on gastric parietal cells rather than any primary alteration in the gastric microcirculation. We conclude that 16,16-dimethyl PGE₂ given orally has no effect on the resting gastric mucosal circulation and that any reduction in mucosal flow during histamine stimulation is secondary to its inhibitory effects on gastric acid secretion.     

Cyclic nucleotide response to acid-secreting stimuli in guinea pig gastric mucosa in vitro

To investigate the mechanism of intracellular transmission of three representative stimuli for gastric acid secretion, the dose-response relations of cyclic nucleotides accompanied by acid secretion stimulated by histamine, pentagastrin and bethanechol were comparatively studied using an in vitro preparation of guinea pig gastric mucosa surviving with a constant potential difference and acid secretion sensitive to amytal. The following results were obtained. (1) Both histamine- and pentagastrin-stimulated acid secretion accompanied a significant increase in cyclic AMP contents in the gastric mucosa and in the serosal solution without any increase in cyclic GMP. However, the ratio of the increase in acid secretion to that in cAMP content was significantly greater with pentagastrin than with histamine, indicating that pentagastrin exerts its acid-secreting stimulus with less increase in cyclic AMP. (2) Stimulation with bethanechol resulted in a significant increase in the mucosal cyclic GMP content without any change in cyclic AMP. From these findings, it has been concluded that the above three stimuli were transmitted differently in the target cells, presenting evidence against the common final mediator theory of histamine for gastric acid secretion.     

Effects of Nocloprost on Gastric Functions in Man

Previous studies in animals and humans demonstrated that nocloprost, a stable prostaglandin E₂ analogue, shows very high gastroprotective potency, relatively weak gastric inhibitory activity, and low systemic bioavailability after oral administration. In this study the effects of nocloprost on gastric acid secretion and intraluminal pH and on gastric emptying and plasma gastrin levels were determined in humans. Nocloprost at doses of 50 and 100 μg was ineffective, but at a dose of 200 μg it reduced the response to pentagastrin significantly and that to a peptone meal by 30–50% and abolished plasma gastrin response without affecting the rate of gastric emptying. Nocloprost given at a dose of 100 μg three times daily 30 min before the major meals (breakfast, lunch, and dinner) did not affect intragastric pH significantly as monitored by continuous intraluminal pH-metry. We conclude that nocloprost does not affect gastric acid secretion or intraluminal pH when applied at a dose (50–100 μg) that is gastroprotective and that is proposed for peptic ulcer therapy. A higher dose (200 μg) of nocloprost causes moderate gastric acid inhibition and suppression of plasma gastrin release without affecting gastric emptying or causing any side effects.     

Effects of nocloprost on gastric functions in man.

Previous studies in animals and humans demonstrated that nocloprost, a stable prostaglandin E2 analogue, shows very high gastroprotective potency, relatively weak gastric inhibitory activity, and low systemic bioavailability after oral administration. In this study the effects of nocloprost on gastric acid secretion and intraluminal pH and on gastric emptying and plasma gastrin levels were determined in humans. Nocloprost at doses of 50 and 100 micrograms was ineffective, but at a dose of 200 micrograms it reduced the response to pentagastrin significantly and that to a peptone meal by 30-50% and abolished plasma gastrin response without affecting the rate of gastric emptying. Nocloprost given at a dose of 100 micrograms three times daily 30 min before the major meals (breakfast, lunch, and dinner) did not affect intragastric pH significantly as monitored by continuous intraluminal pH-metry. We conclude that nocloprost does not affect gastric acid secretion or intraluminal pH when applied at a dose (50-100 micrograms) that is gastroprotective and that is proposed for peptic ulcer therapy. A higher dose (200 micrograms) of nocloprost causes moderate gastric acid inhibition and suppression of plasma gastrin release without affecting gastric emptying or causing any side effects.     

A case of gastrointestinal stromal tumor of the stomach mimicking a primary tumor of the omentum minus due to the extramural growth

We report a case of gastrointestinal stromal tumor (GIST) of the stomach mimicking a primary tumor of the omentum minus. The tumor presented as an isolated mass in the omentum minus without any adhesion to the stomach. Microscopic examination revealed that the tumor pseudocapsule on the gastric side included a small smooth muscle tissue component. The patient was given a diagnosis of a gastric GIST that showed extensive extramural growth. GISTs should not be defined by the localization of the tumor.     

Laparoscopic subtotal gastrectomy for gastric carcinoma treatment

Laparoscopic surgery of the stomach is not well accepted in patients with malignant disease. This paper shows the first experiences with this procedure at the Clinical Hospital and Medical School, Split, in two patients with early stage gastric carcinoma. The first patient was a 57 year old man who had had some gastric symptoms for a while. The other patient was a 73 year old man who had ulcer disease 52 years ago. Laparoscopic subtotal gastrectomy with omentectomy and Roux-en-Y reconstruction of the alimentary tract was performed on both patients. Pathohystological analysis of the resected part of the stomach showed the early stage gastric adenocarcinoma without metastases to the lymph nodes around the stomach or any pathological changes in the omentum for both of the patients. There were no complications during postoperative period. The first patient was released from the hospital after 8 and other after 9 days. All oncological principles were satisfied with laparoscopic subtotal resection with good and fast postoperative recovery without complications.     

Human papillomavirus and the risk of Barrett's esophagus

Human papillomavirus (HPV) is strongly associated with squamous esophageal cancer. The potential role of HPV in Barrett's esophagus (BE) has been examined but remains unclear. The aim of the study was to determine the prevalence of HPV in esophageal and gastric tissues obtained from patients with and without BE. We designed a cross‐sectional study was conducted with prospective enrollment of eligible patients scheduled for esophagogastroduodenoscopy (EGD). All participants had biopsies of endoscopic BE, squamous‐lined esophagus, and stomach. Immunohistochemistry (IHC) on formalin‐fixed and paraffin‐embedded tissue was conducted using monoclonal antibodies. Polymerase chain reaction (PCR) for HPV was performed on DNA extracted from esophageal biopsies snapped frozen within 30 minutes after endoscopic capture. The Roche HPV Linear Array Assay with PGMY primers that has high sensitivity for detecting 37 types of HPV was used. A total of 127 subjects were included: 39 with definitive BE had IHC done on samples from non‐dysplastic BE, squamous esophagus, gastric cardia, and gastric body; and 88 control patients without BE had IHC done on squamous esophageal samples, gastric cardia, and gastric body. HPV was not detected in any of the samples in either group. For confirmation, HPV DNA PCR was performed on randomly selected samples from 66 patients (both esophagus and BE from 13 patients with BE, and 53 esophagus from patients without BE); no sample had HPV DNA detected via PCR in the presence of adequate quality control. HPV infection does not play a role in the formation of non‐dysplastic Barrett's esophagus in men in the United States.     

Absence of hepatic extraction of gastric inhibitory polypeptide in conscious dogs

Fractional hepatic extraction of gastric inhibitory polypeptide was examined in conscious unrestrained dogs with catheters in the portal vein, hepatic vein, and the carotid artery and Doppler flow probes on the portal vein and hepatic artery. Following a control period, endogenous gastric inhibitory polypeptide was stimulated by oral administration of glucose with and without prior infusion of atropine. In other experiments, gastric inhibitory polypeptide (20 ng/kg/min) was infused into the portal system in association with peripheral infusion of glucose. In none of these experiments was it possible to demonstrate any significant fractional hepatic extraction of gastric inhibitory polypeptide.This work was supported by USPHS grant AM 25253 and the Diabetes and Endocrinology Research Center grant AM 27685 Baylor College of Medicine, and The Clinical Research Center Core Laboratory (NIH, GCRC, RR-34) of the Ohio State University Hospital.