The mean level of factor VIII procoagulant acitivity (VIII:C) and factor VIII related antigen (VIIIR:AG) was normal in 100 newborn cord plasmas, whereas that of von Willebrand factor (VIIIR:WF) activity was slightly lower than normal. On crossed immunoelectrophoresis, 20 of 50 newborn infants had an increased anodal mobility of VIIIR:AG. When the cord plasma showing an abnormal electrophoretic pattern was mixed with normal plasma, two precipitation peaks with a broad base were found. Similar mixing experiments with the abnormal cord plasma and plasma from a patient with atypical von Willebrand's disease did not normalize the electrophoretic mobility of VIIIR:AG. Gel filtration of the cord plasma with an abnormal electrophoretic pattern of VIII:AG, showed that the three activities were all detected at the position corresponding to a molecular weight of about 800 000. The results suggest the presence of qualitative abnormalities of the factor VIII molecule in half of full-term newborn cord plasma.
sound examination showed that the tumor was limited within the mucosal layer. Biopsy specimen suggested duodenal adenoma without carcinomatous foci. Because an endoscopic view of the tumor showed that it had a nodular appearance, which suggested the possible existence of carcinoma, endoscopic mucosal resection (EMR) was performed. The lesion was completely removed in a piecemeal fashion. The size of the resected specimen was 35 ¥ 14 mm. Histologic examination revealed tubular adenocarcinoma in the adenoma which was limited to the mucosal layer (Fig. 3). Post-treatment course was uneventful, and there was no evidence of recurrence or metastasis of the carcinoma. Case 2A 49-year-old man presented with a 1-week history of abdominal fullness in March 1995. The physical examination on admission revealed only a mild tenderness of the epigastrium. Results of laboratory study including tumor markers (CEA, 1.5 ng/mL; CA 19-9, 23 U/mL) were all within normal limits. Endoscopy revealed a flat elevation with a central depression in the second portion of the duodenum (Fig. 4). Because the histology of the biopsy specimen was a well-differentiated tubular adenocarcinoma, EMR was performed. The lesion was completely removed en bloc. The resected tumor was 10 ¥ 9 mm in size and histopathologic examination revealed a tubular adenocarcinoma without invasion (Fig. 5). DISCUSSIONPrimary carcinoma of the duodenum is a relatively rare tumor of the gastrointestinal tract. The incidence of this malignancy at autopsy is reported to be 0.02-0.12%. [4][5][6] Recent progress in endoscopic technique has made it possible to diagnose and treat early duodenal carcinoma.Two cases with duodenal carcinoma successfully treated by endoscopic mucosal resection are reported. Case 1 had a semipedunculate polyp, and case 2 had a flat elevated lesion with a central depression in the second portion of the duodenum. Histologic examination showed tubular adenocarcinoma in adenoma in case 1 and an intramucosal adenocarcinoma in case 2, indicating that complete endoscopic resection had been achieved in both cases. Endoscopic mucosal resection appears to be a safe and efficient method for management of early carcinoma of the duodenum as well as in other regions of the gastrointestinal tract.
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