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The prognostic factors influencing survival after operations for gastric cancer in the elderly were evaluated by Cox's proportional hazards model analysis. Data were obtained from 511 operations over a 10-year period, in patients with a mean age of 75.6 +/- 7.9 years. The significant prognostic factors of survival out of 47 examined risk factors were, in order of standardized coefficient values, (1) stage of cancer, (2) %IBW, (3) peritoneal dissemination (P-factor), (4) multiple non-gastric cancers, (5) postoperative hepatic injury and (6) postoperative cardiac complication. No other factors, including preoperative associated diseases and postoperative pulmonary complication (the major risk factor of operative death), were significant risk factors of survival. We conclude that by giving special postoperative attention to prevent hepatic injury and cardiac complication, the length of survival of elderly patients with gastric cancer will improve.

It has common knowledge that the advent of H2-blockers has radically changed the treatment of peptic ulcer. We reviewed 26,667 endoscopic examinations, 5,800 consecutive autopsies and 134 consecutive patients operated for peptic ulcer over an 18-year period to evaluate the effects of H2-blockers on the treatment of peptic ulcer in the elderly (> or = 60 years of age). The number of operations for peptic ulcer in the elderly markedly declined after H2-blocker therapy was introduced. This is mainly due to decreased operative indications for gastric bleeding as a result of conservative treatment. However, the incidence of perforating ulcers has hardly changed even after the introduction of H2-blockers. More than 90% of these cases were non-diagnosed or non-treated ulcers and 50% of them were NSAID- or steroid-treated, which is characteristic in the elderly. We conclude that patients to be treated by anti-inflammatory drugs should be screened by endoscopy, and should be given anti-ulcer drugs prophylactically if necessary.

Gastric ulcer was studied with regard to the relationship with patterns of distribution of intestinal metaplasia (IM). 882 stomachs of elderly patients, obtained from autopsies from 1987 to 1991 were examined histopathologically. There were 74 open gastric ulcers and 88 ulcer scars. Distribution of IM was classified into 7 types. Open ulcers and scars were found more often in type O (IM found in the entire lesser curvature which is the most common type in the elderly) than in other types. Open ulcers in type O were mostly shallow and located in the IM area. Many open ulcers in type A (IM involving the antrum) and type B (IM involving both the antrum and cardia) were deep and on the boundary zone between the IM area and the proper gastric mucosa area. Most of the deep scars that did occur in type O were in the IM area but in types B and A most of them were located on the boundary zone. Scars in type O probably developed on the boundary zone when they were open ulcers and removed in the IM area because of progression of the IM area. In some cases ulcers were at the boundary zone of IM involving the cardia and this finding was characteristic of elderly cases.

We reviewed thirty cases of hepatic hilar bile duct carcinoma found in 5,800 consecutive autopsy cases, mainly of the aged, and analysed their clinicopathological characteristics. Eleven cases had a record of tumor resection (8 men, 3 women, mean age 75.1 years). At operation, the gross type was mainly infiltrative in all eleven cases, and the stage was II, III or IV in as many as ten cases. Cholecystectomy and bile duct resection were performed in all cases except one in whom additional hepatic lobectomy was performed. In none of the cases was the operation curative. The main cause of non-curability was residual carcinoma on the surgical cut or ablated surface due to longitudinal or lateral cancerous interstitial spread. This was confirmed by the fact that local relapse of carcinoma, either in the hepatic hilus or hepatoduodenal ligament, was found in all the cases at autopsy. This fact also indicates the difficulty in achieving complete resection of carcinoma in this part. On the other hand, a relatively "benign" aspect of hepatic hilar bile duct carcinoma was suggested as follows: 1. Most of the cases were well-differentiated adenocarcinoma. 2. Although there was no case of curative resection, three out of of nine cases (excluding the cases of death during operation) survived more than two years. 3. Distant metastasis found at autopsy was relatively rare, being seen in four of these eleven cases. In the light of these data an operation, even though palliative, is considered to be justified.

A thoracoscopic operation was safely performed for a case of a intrathoracic tumor. The patient was a 68-year-old male who had been treated for bronchial asthma and recurrent pneumonia. The reason for a successful operation were one-lung-ventilation under general anesthesia, the thoracoscopic electrocautery, the thoracoscopic ultrasonic surgical aspiration system, and thoracoscopic hemoclips. Pathologically the tumor was a benign mesothelioma. The patient was discharged without complications. In the treatment of intrathoracic benign diseases, thoracoscopic surgery is thought to be particularly useful to patients who are at high-risk in conventional thoracic operations due to accompanying respiratory diseases, as well as to patients requiring incisions as small as possible.

A 10-year experience with 2,441 patients over 65 years of age undergoing operations for non-upper gastrointestinal tracts was reviewed to evaluate both the incidence of postoperative upper gastrointestinal bleeding and the clinical risk factors associated with the complication. A total of 18 (0.7%, 7 males and 11 females) patients had overt postoperative upper gastrointestinal bleeding of non-variceal origin documented by endoscopic findings or blood transfusions. Of these, the complication developed in 10 (1.5%) of 646 patients after an operation for biliary or pancreatic disease, 1 (1.5%) of 64 for aneurysmal or obstructive arterial disease, 5 (1.1%) of 43 for colorectal cancer and 2 (0.3%) of 916 for hernia. The incidences of bleeding after an operation for obstructive jaundice (3.8%), for biliary or pancreatic malignancy (4.5%), and of unavoidable diversion colostomy for colorectal anastomosis (3.1%) were significantly higher than for non-jaundice (0.6%), for non-malignancy (1.1%) and of postoperative upper gastrointestinal bleeding in the present study. The origins of bleeding were gastric ulcer in 11, acute gastric mucosal lesion in 4, duodenal ulcer in 1 and other in 2. All cases of bleeding were treated and met success in hemostasis using H2-blockers. Of these, however, 5 patients died of multiple organ failure despite discontinued hemorrhage, prophylactic use of H2-blockers showed a decrease in occurrence of postoperative upper gastrointestinal bleeding in the present study.

Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to evaluate the prognostic importance of the conditions before abdominal surgery for patients over 60 years of age. Multivariate analyses of postoperative complications were performed in 634 patients (comprising 525 cases of elective abdominal surgery and 109 cases of emergency abdominal surgery). The Mortality rate was significantly higher (p < 0.01) in the emergency group (11.9%) and relatively low among the elective abdominal surgery group (3.8%). In the emergency group, 13 patients died, and MOF (multiple organ failure) was found to be the direct cause of death in 11 (85%). Although, the majority (75%) of emergency operations were for benign disorders, the remainder (25%) had malignant tumors. It is noteworthy that among 25% of cases, obstructions and perforations due to large bowel cancers were found to be 59% and 19%, respectively. In the elective surgery group, postoperative pulmonary and cardiovascular complications were found in 11.6% and 9.6%, respectively. Death due to cardiovascular problems in rare (5%), however, postoperative pneumonia was the cause of death in 70% of all of postoperative death. Risk factors affecting postoperative pulmonary complications were malnutrition, advanced age, male sex, malignant disease, dementia, cerebrovascular disorders, impaired pulmonary function tests. Surprisingly, the risk factors were identical, except for impaired pulmonary function, for postoperative MRSA pneumonia. In our study, postoperative pulmonary death was not associated with impaired pulmonary function, and it appears to be rather affected by the presence of cerebrovascular disorders and malnutritional state. A poor nutritional states (< 40 according to Onodera's nutritional index) was present in over 50% of patients with cerbrovascular disorders and low ADL.(ABSTRACT TRUNCATED AT 250 WORDS)

EEC syndrome is a rare congenital malformation characterized by ectrodactyly, ectodermal dysplasia, cleft lip and/or palate. We reported a case of EEC syndrome with cleft palate. The patient was a 15-month-old girl. She had split hands of the upper extremities, syndactyly and polydactyly of the right lower extremity, ectodermal dysplasia including sparse hair, enamel hypoplasia and cleft palate. The patient underwent palatoplasty at the age of 18 months.

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic manifestation of eosinophilia that may cause endocardial fibrosis and thrombus formation. We presented a 48-year-old man with rapid onset of intractable congestive heart failure during the course of chemotherapy for IHES. After the urgent operation, which included left ventricular thrombectomy and mitral valve replacement the patient was asymptomatic, but died 1 month after operation because of development of IHES. Atrioventricular valve replacement may be beneficial to selected patients with congestive heart failure associated with the cardiac process of the IHES and review of the literature led us to prefer porcine heterograft prostheses in patients with IHES.

A 24-year-old woman with aortic regurgitation and ostial stenosis of coronary artery due to aortitis syndrome was reported. She was admitted to the hospital with anterior chest pain. Retrograde aortogram showed aortic regurgitation and selective coronary angiogram revealed severe ostial stenosis. In spite of steroid therapy, chest pain was not controlled. In spite of the active stage, she underwent aorto-coronary bypass and aortic valve replacement. Intra-aortic balloon pumping (IABP) was necessary to wean from cardio-pulmonary bypass, but she recovered well and no complication was recognized after operation.

We previously reported the short period cure rate of mebendazole (MBZ) treatment to strongyloidiasis. We are now reporting the long period cure rate of the treatment. The results were as follows: 1) The cure rate was 73.9% (17/23) in single use of MBZ (100 mg twice daily for 28 days). 2) The cure rate was 100.0% (22/22) in combination therapy (thiabendazole 500 mg three times a day for 5 days and after that, MBZ 100 mg twice daily for 9 days). Before we obtained the cure rate of 6 months after the treatment described above, we concluded that MBZ could be used for the treatment of strongyloides infection because of the lack of severe side effects and suitable intervals between courses would prevent liver injury. Thus, in this study, 47 patients were treated with 100 mg of MBZ twice a day for 5 days and this treatment was repeated 1, 3 and 4 weeks later on the same schedules (group 1). But because of liver injury, 13 patients were interrupted and moved to the 4th course (group 2). The following results were obtained: 1) Out of a total of 60 patients, the cure rate was 88.1% (52/59) after 2 courses, 92.3% (12/13) after 3 courses and 100.0% (46/46) after the 4 courses were finished. 2) Diarrhea (10.6%), arthralgia and lumbago (8.5%) were observed in group 1. No side effects were observed in group 2. 3) The incidence of liver injury occurred 48.9% (23/47) in group 1 and 30.8% (4/13) in group 2. 4) Positive rate of HTLV-I antibody was 40.0% (24/60).(ABSTRACT TRUNCATED AT 250 WORDS)

A calcium antagonist, verapamil, enhanced the cellular uptake and cytotoxicity of vincristine (VCR) in adriamycin-resistant P388 leukemia (P388/ADM) cells and also enhanced the cellular uptake and cytotoxicity of adriamycin (ADM) in vincristine-resistant P388 leukemia (P388/VCR) and P388/ADM cells. The enhancement of cytotoxicity and cellular uptake of VCR in P388 and P388/VCR cells has been reported previously. [1]. VCR and ADM resistance was circumvented by verapamil. A common transport mechanism for VCR and ADM, which is responsive to verapamil, seems to exist in VCR- and ADM-resistant cells. However, the enhancement of ADM cytotoxicity and cellular uptake by verapamil was not evident in P388 cells.

Fifty-one patients with malar complex fractures were examined with computed tomography to analyze the pattern of displacement in an anteroposterior direction of the face. Malar complex fractures were classified into four groups according to the location and direction of the fragments. Comparisons of the fracture classification obtained by use of CT images with that obtained by conventional radiographic methods demonstrated sufficient correlations between the classification systems to confirm that it is possible to establish a complete three-dimensional pattern of displacement in malar complex fractures using CT imaging.

An unusual case of osteosarcoma of the jaw in a 53-year-old man is reported. The tumor primarily occurred in the right maxilla, and spread to the right mandible. Finally, the patient died of an intracranial extension of the tumor after about 4 years. Microscopically, the tumor was well-differentiated osteosarcoma, but was suspected at first to be fibrous dysplasia.

The effects of maternal alcohol consumption on lipid metabolism in the litter liver were examined in the rat. Rats reared from their fetal period to adulthood with liquid alcohol diet (fetal alcohol group) did not show any lipid accumulation in the livers. Liver perfusion experiments showed an increased oxygen consumption in the liver to a load of physiological concentration of palmitate. On the contrary, the response of oxygen consumption in fetal control rat livers (reared with non-alcohol liquid diet) to palmitate was found to be depressed. 14CO2 production rate from 14C-palmitate in perfused livers showed a significant increase in fetal alcohol group as compared with controls. No difference in 14C-palmitate incorporation into tissue lipid was found between fetal alcohol and fetal control groups. These data indicate that when rats are treated with alcohol from fetal period they acquire an ability to elevate FFA oxidation in the liver through metabolic adaptation.

The electroencephalogram (EEG) was monitored through all phases of enflurane anaesthesia in dental outpatients with a history of cerebral convulsions which had been well controlled with anticonvulsant drugs. Abnormal EEG activity which differed from the background activity was observed in three patients. Their case reports are presented.

A histopathologic study was made on 512 specimens of gastric cancer that were surgically obtained from aged patients (mean age 73 years) in the Tokyo Metropolitan Geriatric Hospital. Of the 512 cases studied, 408 were gastric cancer of the glandular type (80%) and 104 were of the nonglandular type (20%). There were 75 cases of gastric cancer consisting of multiple independent cancer lesions and 71 of these were histologically diagnosed as multiple (2-5) gastric cancers composed of glandular type only. Of these 71 cases, 21 cases were multiple intramucosal cancers. These 21 cases of multiple intramucosal cancers were compared with 49 cases of single intramucosal cancers of glandular type in terms of the maximum diameter of each lesion and the location within the stomach. The results suggest that, in aged patients, there is a great possibility that collision of multiple cancer lesions may result in a single intramucosal gastric cancer measuring over 3 cm in diameter.

The pharmacological actions such as analgesic effect, diuretic action, hypoglycemic activity and hypotensive action were studied on the methanol extract of the Japanese mistletoe and the European mistletoe. The both extracts showed the hypotensive action when administered intravenously to cat. The methanol extract of the Japanese mistletoe also showed a increase of K+ value in the urine when administered orally to rat.

A method for quantitating intracardiac bidirectional shunt and estimating its blood flow is presented. Three curves, defined as "right-to-left shunt curve", "normal pathway curve", and "left-to-right shunt curve" were separately drawn from the original downstream dye-dilution curve, and their areas ?A'', A, A', respectively, were calculated in the conventional manner. A'/A showed left-to-right shunt ratio (QL-R%) even in the presence of right-to-left shunt. However, right-to-left shunt ratio (QR-L%) was given by (1-A'/A)/(A/A'' + 1--A'/A), and equalled A''/(A + A'') only when left-to-right shunt was absent (A' equals O). A''/(A + A) should become increasingly higher than QR-L% with rise in QL-R% (equals A'/A). The relationship between A''/(A + A'') and QR-L% for various A/A isopleths is shown by figure. A good agreement (r equals 0.848, p less than 0.001) was found between QL-R% values by the present method and those calculated by the oxygen method. In contrast, QR-L% values by the present method were consistently lower than those by the oxygen method; the difference was exaggerated especially in cases with history of cardiac failure, and these cases tended to show lower systemic flow. The average difference in QR-L% between the two methods, found in cases free from failure, was 7 per cent. This was thought to be ascribed to intrapulmonary physiological shunt.

Gallbladder bile from 52 elderly subjects who had undergone biliary tract surgery was examined for the presence of bacteria. Twelve patients had sterile bile, 18 specimens of bile yielded anaerobes as well as aerobes, and 22 yielded aerobic bacteria only. Escherichia coli was the most commonly isolated organism (30 strains). Bacteroides fragilis was the most frequently encountered anaerobic bacterium and was found in 15 patients. The Klebsiella-Enterobacter group was the second most commonly isolated group and B. fragilis was third. Clostridium perfringens was recovered in 10 specimens of bile. Anaerobic bacteria were recovered more frequently in patients with ductal obstruction. The relatively frequent isolation of anaerobes, especially of B. fragilis, in this study may be related to the anaerobic techniques used, to the age of the patients, and to the high incidence of pigment stones among the subjects.

Histologic investigation and analysis of 370 polyps, removed via colonoscope, demonstrated a malignancy rate of adenomas of about 20 per cent. Even small adenomas under 1 cm in diameter were found to have a higher malignant potential than previously appreciated. The malignancy rate was higher with increasing size, and adenomas in females had a much higher malignant potential than in males. It is obvious that colonoscopic polypectomy is valuable in detecting and treating early carcinomas of the colon.

An 81-year-old woman, diagnosed as having a lower bile duct carcinoma by percutaneous transhepatic cholangiography and cytology of the bile after the onset of repeated nausea and fever around November, 1986, was given a pancreatoduodenectomy in February, 1987. From histological analyses of specimens taken at surgery, papillary adenocarcinoma of the lower bile duct was revealed with a massive amount of mucin in the cancerous gland lumens, the bile duct and the tubular adenocarcinoma retained in the mucosal layers of the gallbladder. Lying between these carcinoma sites was found atypical epithelia of a lesion borderline between benign and malignant (Group III). The patient's postoperative progress was fair, but she died suddenly of cerebral hemorrhage in July, 1988. No intraperitoneal or general carcinoma relapse was found at autopsy. This is one of the relatively rare cases of a simultaneous development of gallbladder and bile duct carcinomas and we found it of great interest that these carcinomas existed through an intermediate atypical epithelium.