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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.

BACKGROUND. The prevalence of complementary and alternative medicine (CAM)is increasing worldwide because of the growing public interest in natural or holistic therapies and because of the flow of information through the Internet. However, there is a lack of communication between cancer patients and their physicians on topics relating to CAM. The authors performed a cross-sectional survey to evaluate the perceptions and attitudes of Japanese clinical oncologists toward cancer CAM. METHODS.The CAM questionnaires were sent to 2118 clinical oncologists. The questionnaires gathered data on background (age, gender, years in practice, specialty, and knowledge of cancer CAM), perception (effectiveness/ineffectiveness, scientific evidence, and drug interactions), and attitude (experience with and response to CAM users). Questions about oncologists' perceptions and attitudes to CAM were limited to herbs and other natural products that were sold over the counter. RESULTS.One hundred sixty-six questionnaires were returned as undeliverable. Of the remaining questionnaires, 751 were returned (a response rate of 39%). Twothirds of the responders were surgical oncologists and most of the remaining responders were medical oncologists. The majority of oncologists (82%) believed that CAM products were ineffective against cancer. The main reason for this belief was a lack of reliable information (as cited by 85% of oncologists). Only 13% of oncologists had experienced CAM-associated disease improvement in their cancer patients. Of all the oncologists, 84% considered the possibility of drug interactions between anticancer drugs and CAM products. The majority of oncologists (80%) replied that they could neither promote the use of CAM products nor recommend quitting the products, when they were asked about the use of CAM products by cancer patients. I nterest in complementary and alternative medicine (CAM) has grown rapidly in the past decade. Some of the reasons for the increased interest include Internet marketing, dissatisfaction with mainstream medicine, and a desire of patients to be involved actively in their own health care, especially natural or holistic therapies. 1,2 The use of CAM has become prevalent in most industrialized countries. CONCLUSIONS. © 2003 American Cancer SocietyFor example, 48% of the population in Australia, 3 70% of the population in Canada, 4 42% of the population in the U.S., 5 31% of the population in Belgium, and 49% of the population in France 6 have used CAM at least once.By the 1990s, surveys showed that CAM was being used widely by cancer patients. The prevalence ranged from 7% to 64% of patients sampled in 26 studies conducted worldwide. 7 Complementary and alternative medicine in cancer medicine (e.g., Chinese traditional remedies, acupuncture, and other natural products, such as shark cartilage and beeswax-pollen mixtures) is widely available in Japan and Western countries. We found that 32% of cancer patients in Japan used CAM without having sufficient information. 8 There was a lack of commun...

Objective In recent years, the number of elderly patients with early gastric cancer (EGC) has steadily been increasing. In our institute, endoscopic submucosal dissection (ESD) involving the use of an insulated-tip diathermic knife (IT-ESD) was introduced for the treatment of mucosal gastric carcinoma in 1996. The purpose of this study was to evaluate the effectiveness of IT-ESD for the treatment of elderly patients with EGC.Materials and Methods A total of 144 patients with EGC were treated at Shikoku Cancer Center in the 5-year period from January 2000 to December 2004, including 53 patients over 75 years old. The performance status (PS) for all patients was less than 2. We compared patient's backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, perforation rate, blood pressure, and peripheral oxygen saturation (SpO2) between patients over 75 years of age (elderly group) and the remaining 91 younger patients (non-elderly group).Results The rate of having underlying disease was significantly higher for the elderly group (p<0.05) and we found no significant difference for the one-piece resection rate, CR rate, operation time, bleeding rate, and perforation rate between the 2 groups. There were also no significant differences for the frequency of the use of oxygen, pressor and depressor between the 2 groups.Conclusion There was no significant difference in the outcome resulting from ESD between the 2 groups. Our study proves that ESD is a feasible treatment for elderly patients with EGC PS of less than 2. (Internal Medicine 44: 1033-1038, 2005)

The high improvement rate in abdominal symptoms suggested the efficacy of octreotide in terminally ill patients with malignant bowel obstruction.