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For the purpose of studying the clinical and pathological specificities of the scirrhous type in gastric carcinoma, 96 patients with gastric carcinoma were studied according to age, sex, stage, macroscopic types and mitotic index. Scirrhous carcinoma was diagnosed in 45 patients. There were higher incidences of scirrhous carcinoma in the younger generation and among women. In the scirrhous type, the percentage of stages III and IV was higher than that of stages I and II (p less than 0.005). In Borrmann's categories III and IV, patients with the scirrhous type were more numerous than those with the other types. Mitotic indices were 18.4 +/- 8.1 in scirrhous type, 52.8 +/- 13.5 in medullary type, 54.1 +/- 16.9 in intermediate type and 53.3 +/- 11.5 in non-cancerous gastric mucosa. The low rate of mitotic index in those with scirrhous carcinoma was statistically significant compared to those of other types and that of the non-cancerous gastric mucosa (P less than 0.001). Mitotic index is apparently related to the extent and the degree of degeneration of interstitial connective tissue. The speed of the growth of the tumor mass in gastric carcinoma is not so closely related to the mitotic index, and relates to a greater extent the number of dissociated cells entering the digestive canal.

Serum CEA measured by radioimmunoassay was studied in 63 colorectal cancer patients. The present study was designed to assess the usefulness of serum CEA assay on the diagnosis of colorectal cancer at various stages and in the care of prognosis. CEA was examined before and after surgery at appropriate intervals. Serum CEA test was positive (over 2.5 ng/ml) in 10.5% of the 19 patients with Dukes stage A, in 61.9% of 21 patients with Dukes stage B, and in 78.3% of 23 patients with Dukes stage C. Curative resection was able to perform in all of colorectal cancer patients with values of less than 2.5 ng/ml, in 75% of them with values of 2.5-10 ng/ml and in 45% of them with values of greater than 10 ng/ml. High serum CEA levels decreased to normal levels within 1-3 months after curative resection. High CEA levels were observed before the secondary operation in 4 out of 5 patients who underwent reoperation because of the evidence of recurrence. CEA decreased to normal levels in 3 of them and increased to 500 ng/ml in 1 case. In the last case CEA sustained high levels until the death due to metastasis to the lung and lymph nodes.

Surgical experience of a rare case of malignant retroperitoneal cyst is reported. A 41-year-old female was admitted on Feb. 26, 1986, complaining of left lower abdominal tumor and mild abdominal pain. She underwent complete removal of an abdominal tumor located at the left flank lateral to the sigmoid colon on March 5. The tumor was well encapsulated, cystic and oval, 12 X 10 X 9 cm in size. Histologic feature of the tumor is classified as mucinous cystadenoma of low grade malignancy by WHO classification.

A prospective randomized controlled trial of adjuvant chemotherapy for colorectal cancer was performed in 41 institutions in the Tokai district. In the study, postoperative administration of Mitomycin C (MMC) followed by carmofur (HCFU) for more than three months (arm B) was compared to MMC alone (arm A). Of 173 patients subjected to curative resection (arm A = 80, arm B = 93) for colorectal cancer, 148 including 69 from arm A and 79 from arm B were evaluable. Before clinical evaluation of the effectiveness the background factors were analyzed by the chi square test and U-statics. There were no differences between them. At four years after surgery Kaplan-Meire's life table showed that the disease free survival of arm B was superior to that of arm A, but this difference was not statistically significant (generalized Wilcoxon test: P less than 0.10). However, the survival in arm B was significantly prolonged as compared with that in arm A (P less than 0.05). Side effects such as leukopenia and gastrointestinal distress caused by administration of MMC and pollakisuria and gastrointestinal distress caused by administration of HCFU were observed in approximately 35% of the patients. They were all slight or moderate and reversible.

The host defense mechanism was fundamentally and clinically investigated from the aspect of tumor immunology. The behavior of macrophages in the immune systems of experimental animals demonstrated different patterns of response in the bone marrow, peritoneal cavity and spleen, respectively. It was doubtless that the spleen occasionally exerted an immunosuppressive action. Ectopic immunization of syngeneic rats with normal liver cells resulted in specific inhibition of the growth of the tumor cells (AH-I30) derived from liver. This seemed to strongly suggest a local immune response. In clinical cases, the host defense mechanism was found to collapse due to surgical intervention, malnutrition and immunosuppressive substances. The relation between complements and host defense mechanism has been controversial. Our studies indicated the serum complement level to be the most reliable parameter for understanding the host defense mechanism. Since the combination of immunostimulants and anticancer drugs is likely to induce anticancer drugs to exert an adverse effect depending on the time of such combination, timing of combined administration of drugs should be chosen with great care.

One week after the sc injection of minced tissues of the livers, kidneys, or spleens of W, Donryu, and MP rats into the left back of syngeneic rats, ascites-type tumor cells derived from rat hepatoma (AH 130) or Walker carcinosarcoma cells derived from rat breast tumor were inoculated sc into the right back. Ascites hepatoma cell growth was slowest in the group given the liver preparation, whereas no significant difference was noted in the growth of Walker carcinosarcoma in all groups. The results were similar in all strains.

An attempt was made to clarify the clinical prognosis of scirrhous type of gastric carcinoma and to improve its treatment. The cases of gastric carcinoma operated and histologically well analyzed from 1969 to 1973 was 178, and scirrhous type was included in 52%. Advanced carcinoma (more than ss alpha) was 80% in scirrhous type and 40% in non-scirrhous type. Five year survival rate in scirrhous type was 45% and 59% in non-scirrhous type. (P divided by 0.09). In pm carcinoma, however, the 5 year survival rate of scirrhous type was higher than that of non-scirrhous type (P divided by 0.06). Between the primary lesions and lymphatic metastasis, histologic type was not the same in 70%. The survival rate of scirrhous type in lymphatic metastasis was again higher than that of the non-scirrhous type. Mitotic index was 18.6 +/- 8.6 in scirrhous type, 52.8 +/- 13.5 in medullary type, 54.1 +/- 16.5 in intermediate type and 53.3 +/- 11.5 in non-cancerous gastric epithelium. For the scirrhous type with a large amount of highly degenerated interstitial and poor blood vessel supplying, many doses of chemotherapeutic agents may be necessary, and, especially, cytostatic agents should be administered for long periods.

Ogilvie's syndrome is caused from functional obstruction of the colon without mechanical stenosis and also termed as pseudo-obstruction of the colon. This disease is seen in patient who has other causative distress. The pathogenesis of this rare entity is unknown but it is suspected that there may be an underlying autonomic disturbance which causes non-mechanical obstruction of the colon. Most of the case reports on Ogilvie's syndrome have appeared in European and North American journals but are extremely rare in Japan. Some cases which have been categorized "spastic ileus" may be included in this syndrome. We recently experienced a patient with cerebral infarction who developed non-mechanical obstruction of the colon. This patient was treated successfully with an exploratory laparotomy and sigmoidostomy. It is considered that early diagnosis is an essential part of the initial management of this syndrome. Conservative treatment is indicated for most of the patients but a definitive surgical therapy is occasionally necessary.