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Background: The breast conserving surgery and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. When the tumor exists in the medial or lower side of the breast, we usually use the periareolar incision. However, it often makes deformation or malposition of nipple and areola, and sensory disturbance around them. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor even in the medial or lower side of the breast without making any injuries on the breast skin. And it can preserve skin touch sensation. Methods: We have performed video-assisted breast surgery (VABS) on 300 patients since December, 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic sentinel lymph node biopsy, we elongated the axillary skin incision to 2.5 cm. We marked the surgical margin 2 cm apart from the tumor edge by injecting blue dye into subcutane and retromamma. We dissected major pectoral muscle fascia to detach retromammary tissue under the tumor. The working space was made by lifting traction sutures through the gland. We cut the proximal side of the gland vertically at dye marking points, and dissect skin flap over the tumor by tunnel method. Then we cut each sides of the gland vertically and removed it through the axillary port by using Endocatch, tumor collection bag. The breast reconstruction was done by filling absorbable fiber cotton, oxidized cellulose. Results: The tumor size was 2.2 cm on average. The patient age was 50.2 years. We had to take much care not harming the skin over the tumor. TRAM was performed without major complications. The working space was made only enough for the resection of the gland without excessive detachment of the surrounding subcutaneous tissue. The fifty tumors in the medial side of the breast were resected in success by TARM. Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like burn. All surgical margins were negative. The operation time was needed 45 minutes longer than the conventional VABS operation, but the blood loss and other surgical stress factors were not significantly different. The postoperative esthetic results were good. The oxidized cellulose cotton was good for preserving the breast form, because it collects fluid to make temporal seroma and became a solid fibrous mass on six months after surgery. The average follow up period is 60 months. There was only two local recurrences. The sensory disturbance was minimal. All patients were satisfied with this operation. Conclusions: This newly devised TARM approach of VABS needs no injury on the whole breast, and can become to be a standard method of the breast conserving surgery for early breast cancer wherever it may exist in the breast. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-08.

The preservation of the axillary node (AN) has become standard therapy for early breast cancer patients with a metastasis-positive sentinel node (SN). However, about half of the patients with metastasis in the SN have no metastasis in the other AN. Late-phase three-dimensional computed tomographic lymphography (3D-CT LG) of the breast can show the axillary lymphatic architecture from the SN into the venous angle. These nodes are classified into five groups. For the sake of aesthetics, video-assisted breast surgery (VABS) was used to sample the second and third nodes shown by 3D-CT LG. For marking the SN on the skin, 3D-CT LG was performed the day before the surgery. Iopamiron 300 (2 ml) was injected subcutaneously. A 16-channel multidetector-row helical CT image was reconstructed to produce a 3D image of the lymph ducts and nodes. A biopsy of the SN was performed by the dye-staining method using Visiport-aided endoscopy for VABS. Stained nodes were located by following the dye in the lymph ducts on a video monitor. For SN-metastasis-positive patients, standard AN dissection was performed under video assistance. Since July 2002, the authors have performed SN biopsy for 186 patients as well as 3D-CT LG and VABS SN biopsy for 146 patients. Five chained-node groups were shown. Even in the multiple SN case, the lymph ducts were converging into the second node. The second and third nodes beyond the SN were detected and sampled in 82 patients (56.2%) by VABS assisted with 3D-CT LG. Sentinel node metastasis (n = 40) involved SN metastasis alone in 21 cases (52.5%) and SN, second-node, and third-node metastasis in eight cases. A reviewed lymphoid path by 3D-CT LG confirmed that metastasis occurred in order of lymph flow. The use of 3D-CT LG-guided VABS SN biopsy of the second and third nodes will predict SN metastasis alone and help to obviate the need for dissection of more nodes.

Aims: Recently, endoscopic mucosal resection (EMR) has become the first choice of treatment for superficial esophageal cancer without metastasis. However, EMR is not safe for all patients. Argon plasma coagulation (APC) is a noncontact electrocoagulation technique that creates tissue damage. The risk of bleeding may be lower with APC than with EMR. Therefore, we selected APC for the treatment of patients with superficial esophageal cancer who could not undergo EMR. The aim of the present study was to describe these cases and analyze the results of this treatment. Patients and Methods: Ten patients with superficial esophageal cancer underwent APC at our institution from February 2001 through January 2002. None of the patients could undergo EMR because of complications. Ablation was performed using an APC probe (ERBE APC probe; ERBE Elektromedizin, Tubingen, Germany), a high-frequency electrosurgical generator (ERBE ICC200), and an argon delivery unit (ERBE APC 300). All patients had uneventful recoveries. Results: No incidents of bleeding from the ablated lesion or infection occurred. Oral intake was resumed on the day after treatment. The mean duration of the procedure was 20 minutes (range, 10 to 40 minutes). Disease recurred in two patients. Two patients died of laryngeal cancer and liver failure, respectively. Conclusion: APC is a safe and easy to perform procedure, but the effect of therapy is inferior to that of EMR in terms of the complete resection of the lesion. In conclusion, APC should be limited to cases of superficial esophageal cancer without metastasis in which EMR has been deemed difficult.

Recent reports suggest that Helicobacter pylori infection can potentially increase the risk of colorectal cancer. The purpose of this study was to assess the association between H. pylori infection and the risk of colorectal adenoma and adenocarcinoma, and to evaluate any differences on the basis of sex. The subjects were 669 (40- to 80-year-old) patients who underwent both barium enema examination and total colonoscopy, and who were evaluated for H. pylori infection by 13C-urea breath test, urease test, or histological diagnosis of biopsied gastric specimens. There were 142 H. pylori-negative and 527-positive patients. The odds ratios (ORs) for H. pylori-positive patients with colorectal adenoma and adenocarcinoma, and for tumor patients with either adenoma or adenocarcinoma were calculated. Among the H. pylori-negative patients, there were 52 patients without tumor, 63 with adenoma, 27 with adenocarcinoma, and 90 with tumor. Among the H. pylori-positive patients, there were 136, 264, 127, and 391 patients respectively. Pooling all subjects, those infected with H. pylori had a significantly increased OR for adenoma, adenocarcinoma, or tumor, compared to H. pylori-free patients (OR, 1.60, 1.80, and 1.66, respectively). For female H. pylori-positive subjects, the risk of having adenocarcinoma or tumor was significantly higher than that for their H. pylori-free counterparts, while for male H. pylori-positive and -negative subjects, there was no such significant difference. The results therefore suggest that, in patients aged 40–80 years, H. pylori infection increased the risk of colorectal adenoma and adenocarcinoma, with significantly higher risks for female patients.

Bleeding from esophagogastric varices is a catastrophic complication of chronic liver disease. We have been attempted surgery, embolization, and endoscopic treatment for the treatment of esophagogastric varices. Endoscopic injection sclerotherapy (EIS) is an established treatment for esophageal varices. EIS is associated with a high incidence of local and systemic complications. Endoscopic variceal ligation (EVL) is increasingly used because of its safety and simplicity and because no sclerosant is used. Nevertheless, EVL is not always effective, and early recurrences have been reported. Furthermore, most patients with esophageal varices treated endoscopically require treatment for recurrent varices. We invented that EVL performed three times at bimonthly intervals. EVL performed at bimonthly intervals for the treatment of esophageal varices attained a higher complete eradication rate, a lower recurrence rate, and a lower additional treatment rate. It is generally believed that bleeding from gastric varices is more severe than bleeding from esophageal varices, but bleeding from gastric varices occurs less commonly than from esophageal varices. The endoscopic risk factors for bleeding from esophageal varices include presence of raised red markings, cherry-red spots, blue color, and large size. However the risk factors for bleeding from gastric varices have yet to be characterized. Once gastric variceal hemorrhage did occur, bleeding from these varices was successfully stopped in all cases. Therefore, prophylactic treatment of gastric varices is not recommended.

血中carcinoembryonic antigen (以下, CEA と略記) 値が異常高値を呈し, 再発と治療効果に対して有用な指標となった進行食道扁平上皮癌の1例を経験したので報告する. 症例は70歳の男性で, 嚥下困難を主訴に, 近医にて上部消化管内視鏡検査を施行. 胸部上部食道に腫瘍を認め, 生検にて扁平上皮癌と診断, 精査加療目的に当科紹介となった. 入院時血中CEA値は19ng/mlと高値を示した. 諸検査にて他臓器病変は認めず, 進行食道扁平上皮癌と診断し, 術前化学放射線療法を施行後, 右開胸開腹食道切除術施行. 血中CEA値は2.0ng/mlと正常化し退院となった. その後, 血中CEA値の上昇とともに右側反回神経リンパ節再発, 吻合部浸潤の診断にて4回入院し, 化学放射線療法および化学療法を施行. おのおのの入院治療後は腫瘍の縮小と血中CEA値の低下を認めたものの, 最終的には再発腫瘍の増大のため術後24か月目に死亡した.

Gastrointestinal stromal tumor is a mesenchymal tumor of the digestive tract. Although there used to be no effective therapy for the tumor, there have been many recent reports on the efficacy of imatinib. We report on a 53-year-old female patient with a primary tumor of the jejunum who underwent 3 operations. As the tumor could not be removed at the 3rd operation, she was given imatinib orally. Results showed significant reduction ratios of the tumor area (83.0%) and volume (92.2%) at 18 months after starting imatinib administration. Also, the mean reduction ratios of the tumor area and volume per month (%/M) after starting imatinib treatment showed remarkable results, especially during the initial 3 weeks: 53.9%/M and 49.5%/M, respectively. Whether imatinib is the first choice of treatment for GIST or not, and what is the appropriate dose and period should be resolved.

大腸癌においてリンパ節転移程度は重要な予後因子である.今回, stage III結腸癌134例を対象とし,リンパ節転移分類法と予後との関係から最適なリンパ節転移分類法を検討した.大腸癌取扱い規約におけるリンパ節転移分類法(n1, n2+n3),転移個数による分類法(3個以下, 4個以上),転移度による分類法(25%未満, 25%以上)において5年累積生存率を算出したところ,転移個数分類でのみ有意差を認めた(p=0.0128).多変量解析では,壁深達度(se以深, ss以浅) (ハザード比2.636: 95% CI 1.295-5.367),リンパ節転移個数分類(4個以上, 3個以下) (ハザード比3.620: 95% CI 1.392-9.414)の2因子で有意差を認め,独立した予後因子であった.今回の検討より転移個数による分類は簡便で予後をよく反映し,独立した予後因子でもあることからstage III結腸癌の亜分類にリンパ節転移個数を加味するのは妥当と考えられた.

A 63-year-old man presented to our hospital with persistent dysphagia. Radiologic and endoscopic examination disclosed a 2.0-cm exophytic tumor in the middle third of the esophagus. An endscopically obtained biopsy specimen was found to represent undifferentiated small cell carcinoma. Computed tomography of the chest, abdomen, and cervical region was performed, as were gallium and bone scintigraphy. Metastasis to an adjacent lymph node was detected, without metastasis to distant organs. After neoadjuvant chemotherapy with carboplatin (CBDCA) (400 mg/m2) and etoposide (VP-16) (100 mg/m2), endoscopy and barium-swallow esophagography showed regression. Thoracic esophagectomy then was performed with mediastinal, abdominal and cervical lymph node dissection. The resected tumor was polypoid, measuring 0.5 x 0.5 cm. The lesion consisted mainly of small anaplastic cells, but included a small focus of squamous cell carcinoma. The patient has survived for more than 7 months with no further treatment and no evidence of recurrent disease.

Background: We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices. Methods: Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde-disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium. Results: Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P

The Nippon Medical School New Tokyo International Airport Clinic(Airport Clinic)was opened in 1992 as Japan' s first 24‑hour international airport clinic. To date it has provided medical services to a total of 117953 patients. Of these 85545(72.5%)were airport employees 28662(24.3%)were passengers and 3746(3.2%)were others. Of the total non‑Japanese patients accounted for 8485(7.2%) . In the year to March 31 2001 the Clinic treated an average of 43.9 cases per day. The number of emergency patients was 2969 or 2.3% of the total of whom 500(0.4%) were non‑Japanese. There were 47 deaths with age ranging from 14 to 84(average age 64.0) . The ratio of males to females who died was 28: 19. Of the 47 deaths 18 were non‑Japanese. Pulmonary thromboembolism is considered to have played a role in 25 of the deaths. Based on more than 8 years of airport clinical experience we believe that a first‑class international airport should have excellent medical facilities that can provide quality emergency medical services to travelers and disaster victims. (J Nippon Med Sch 2002; 69: 185―191)

Background and Objectives Cyclin D1 is known to play important roles in the G1/S check-point of the cell cycle. We investigated the correlation between cyclin D1 overexpression and clinical characteristics to clarify its prognostic significance in patients with esophageal cancer. Methods From 1991 to 1998, cyclin D1 was investigated in esophageal cancers from 86 patients who underwent esophagectomy. Overexpression of cyclin D1 was demonstrated using an immunohistochemical method. Results Overexpression of cyclin D1 was found in 23 (26.7%) of 86 cases. Overexpression of cyclin D1 correlated with lymph node metastasis (P = 0.0083) and lymphatic vessel invasion (P = 0.018). Cyclin D1 overexpression may indicate resistance to chemotherapy. The patients with cyclin D1 overexpression had a significantly lower survival rate than those without overexpression (P = 0.013). The multivariate analysis revealed cyclin D1 overexpression to be an important prognostic factor in patients with esophageal cancer. Conclusions Immunohistochemical examination of cyclin D1 expression may provide important prognostic information in univariate and multivariate analysis and may be necessary for determining therapeutic strategies for esophageal cancer. J. Surg. Oncol. 2001;78:208–214. © 2001 Wiley-Liss, Inc.

It is now 24 years since the opening of New Tokyo International Airport. Nippon Medical School New Tokyo International Airport Clinic (Airport Clinic) was opened in December 1992 and is located in terminal 2 of the airport. We have treated 85,545 airport personnel (72.5%), 28,662 passengers (24.3%) and 3,746 other patients (3.2%), a total of 117,953 patients in its 8 years and 4 months of services so far. There were 8,485 non-Japanese patients (7.2%). There were 47 incidents of cardio-pulmonary arrest at the clinic of which 25 were suspected to be caused by pulmonary thromboembolism, otherwise known as the economy-class syndrome. Furthermore, out of the 75 severe and serious cases of pulmonary thromboembolism, there were 50 survivals and 25 fatalities. 14 of these cases were confirmed to be pulmonary thromboembolism while 61 cases were suspected of this disease. The age ranged from 21 to 95 with an average age of 59.1 years and the ratio of male to female patients was 31:44. The age range of the 14 confirmed cases were from 48 to 78 with an average age of 62.0 years and the male to female ratio was 1:13. There were 2 fatalities in the confirmed cases; both were women aged 66 and 69. The age of the 12 survival cases ranged from 48 to 78 with and average age of 61.0 years and the male to female ratio was 1:11. All these patients are now socially rehabilitated. The medical consultation rate was 1 in 4,000, the number of emergency medical care was 1 in 80,000 and the number of fatalities was 1 in 4 million passengers, roughly calculating from the figure of 26 million passengers a year at Narita Airport. The number of fatalities resulting from pulmonary thromboembolism was estimated at 1 in 7.5 million.

Background: We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival. Methods: Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions. Results: Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) ( p Conclusions: Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence. (Gastrointest Endosc 1999;50:7-12.)

A patient who presented with multiple esophago-gatroduodenal ulcer associated with hypergastrinemia developed a stricture of the esophagus due to cicatrization of the ulcer and perforation of duodenal ulcer. An impregnation of the greater omentum into the perforation site and gastrotomy were performed, and then a H2 receptor antagonist (ranitidine) and a proton pump inhibitor (lansoprazole: PPI) were administrated when the effects were evaluatd on the total volume of gastric juice collected. A significant decreasing effects of gastric juice and pH were obtained when PPI was administrated at double dose. For hypergastrinemia in which various imagings, angiography, and selective measurement of srum gatrin levels failed to confirm the localization of gastrinoma, and for the severe esophageal stricture, the stomach which is the target organ of gastrin was totally removed in a two-step approach and the patient successfully recovered. However, thereafter, the patient experienced various malignancies in a short period, including a polyp of the sigmoid colon soon after the operation, a left colonic cancer one year later, and its hepatic metastasis 6 months after the colonic cancer. Furthermore, serum gastrin levels varied along with total gastrectomy, resection of the sigmoid colon and hepatectomy. It is noteworthy that there might be some correlations between hypergastrinemia and progression of malignant tumors.

The development of gastric cancer is a multistep process that is multi-factorial. An association with the Helicobacter pylori infections, gastric atrophy and gastric cancer has received recent attention. The objective of this study was to elucidate the risk factors for gastric cancer by using molecular epidemiological techniques for genetic susceptibility, gastric atrophy and serum markers including H pylori infection. We used an age- and gender-matched case-control study, where patients with benign gastric lesions were the controls. Low serum pepsinogen I levels (cut-off50 ng/mL) and low pepsinogen I/pepsinogen II ratios (cut-off3.0) were significantly associated with the risk of gastric cancer (odds ratio [OR] = 3.53: 95% confidence interval [CI] = 2.46-5.09 and OR = 4.73: 3.26-6.88, respectively). However, seropositivity of serum immunoglobulin G (IgG) antibody against H pylori (OR = 1.09: 0.74-1.61) was not associated with gastric cancer, even when analyzed by age greater than or less then 50 years. Specific genotypes of the cytochrome p450 2E1 (CYP2E1) RsaI polymorphism and glutathione-S-transferase (GST) M1 gene deletion were determined but were not associated with gastric cancer; however, a Lmyc genetic polymorphism was associated with gastric cancer (OR = 1.55: 1.03-2.34). Therefore, in this Japanese study, atrophic mucosal change, indicated by serum pepsinogen levels, is a possible risk factor for gastric cancer.

Evidence showed a marked decrease in recurrence rate of peptic ulcer after eradication of Helicobacter pylori infection. However, whether H. pylori infection is etiologically related to perforation of peptic ulcer remains to be clarified. We therefore conducted an age- and gender-matched case-control study between perforated and nonsurgical peptic ulcers in H. pylori infection and examined differences in the cytotoxin genes cagA and vacA. Serum H. pylori IgG antibody (ELISA) was positive in 20/21 (95%) of perforated vs. 37/40 (93%) of nonsurgical duodenal ulcers and in 5/5 (100%) of perforated vs. 24/28 (86%) of nonsurgical gastric ulcer patients. Positivity of H. pylori DNA in gastric juice, which was amplified by PCR and identified by Southern blot hybridization, was 17/23 (74%) of perforated vs. 32/45 (71%) in the nonsurgical duodenal ulcer group. Positivity of the cytotoxin genes cagA and vacA in H. pylori DNA-positive gastric juice was as follows : perforated vs. nonsurgical duodenal ulcer, cagA 11/ 13 (85%) vs. 24/27 (89%); vacA1: 9/13 (69%) vs. 22/27 (82%); vacA2 8/13 (62%) vs. 21/27 (78%). There were no significant differences between the perforated and nonsurgical peptic ulcer groups for these H. pylori serum and gene markers. It is assumed that H. pylori infection is not etiologically related to perforation of peptic ulcer.

Superior mesenteric artery (SMA) syndrome often has geneses such as rapid growth in height only, anorexia nervosa and lordosis, in that patient is commonly thin or emarciated. In this country, 101 cases have been reported in a recent 11-year period from 1985 to 1995, 74 cases (7.3%) were young age under 29 years old, only 12 cases (11.8%) were old age over 60 years old. This paper presents a case performed anterior transposition method with Billroth I method for SMA syndrome with early gastric carcinoma and multiple gastric ulcers. A 67-year-old emarciated man was admitted to the hospital because of abdominal pain and vomiting. By hypoduodenography, angiography and ultrsonography SMA syndrome was diagnosed and gastrofiberscopy revealed on early gastric carcinoma with multiple gastric ulcers. As to the operative procedure for SMA syndrome, bypass method (duodeno-jejunostomy, side to side anastomosis) has been performed in 75% of these patients, and anterior transposition method which we choiced, in only 10%. The latter method, however, appears to be the most appropriate method in terms of the pathophysiology.

BACKGROUND Gastric cancer is a multistage process, each caused by numerous factors. The objective of this study was to elucidate the risk factors for gastric cancer by using molecular epidemiologic techniques and serum markers. METHODS Serum pepsinogen I levels, pepsinogen I/pepsinogen II (I/II) ratios, serum IgG antibody against Helicobacter pylori (H. pylori), and genetic polymorphisms of cytochrome p450 2E1 (CYP2E1), glutathione-S-transferase M1 (GSTM1), and L-myc protooncogenes were analyzed in 82 persons with gastric cancer and in 151 age- and sex-matched controls, who were selected from 208 gastric cancer patients and 375 noncancer patients, respectively. Statistical analysis was performed to elucidate which risk factors for gastric cancer were contributing the most to gastric carcinogenicity. RESULTS Serum pepsinogen I level (odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.04–3.16) and pepsinogen I/II ratios (OR = 3.09; 95% CI, 1.74–5.49) were significantly associated with gastric cancer risk in a case–control study. Seropositivity of serum IgG antibody against H. pylori (OR = 1.25; 95% CI, 0.84–1.85) and specific genotypes of a L-myc genetic polymorphism (OR = 1.33; 95% CI, 0.59–2.99) were more commonly observed in gastric cancer cases, but this was not statistically significant. Specific genotypes of the CYP2E1 RsaI polymorphism and GSTM1 gene deletion were not associated with gastric cancer. CONCLUSIONS Atrophic mucosal change, indicated by serum pepsinogen levels, is possible a risk factor for gastric cancer. H. pylori infection and genetic polymorphisms of CYP2E1, L-myc, and GSTM1 genetic polymorphisms were not risk factors in this study. Cancer 1996;77:1654-61.

The detection of Helicobacter pylori in gastric juice by the polymerase chain reaction (PCR) was undertaken in 124 patients with peptic ulcer or chronic gastritis. PCR products were evaluated by agarose gel electrophoresis and Southern hybridization of H. pylori-specific DNA sequences. Positive and negative results of the PCR analysis in 72 examinations were compared with those from bacterial culture, and with the detection of tissue IgA antibody against H. pylori by enzyme-linked immunosorbent assay ELISA; Serion, Wuerzburg, Germany, and detection of serum IgG antibody against H. pylori by ELISA; Radim Pomezia, Italy. Thirty-four PCR-positive samples evaluated by electrophoresis and hybridization coincided with positive samples in 56% of bacterial cultures, 59% of tissue IgA antibody identifications, and 94% of serum IgG antibody evaluations; 26 PCR-negative samples coincided with negative samples in 96% of bacterial cultures, 81% of tissue IgA antibody evaluations, and 38% of serum IgG assessments. We compared the detection achieved with the H. pylori PCR assay in gastric juice with that in biopsies taken from the antrum and upper corpus in 90 examinations, and found them to be both positive in 34 (38%) and 36 (40%) of specimens, both negative in 37 (41%) and 30 (33%) specimens, gastric juice-positive but biopsy-negative in 10 (11%) and 12 (13%) specimens, and vice versa in 9 (10%) and 12 (13%) specimens, when detected by electrophoresis and hybridization, respectively, showing equivalent detection rates. In relation to the type of disease, the positive PCR assay results with gastric juice, evaluated by electrophoresis and hybridization, respectively, were: gastric ulcer 34/53 (64%) and 39/53 (74%), duodenal ulcer 23/38 (61%) and 25/38 (66%), and chronic gastritis 20/33 (61%) and 23/33 (70%), showing no significant difference in positive rates between peptic ulcer and chronic gastritis. Of the samples of 16 patients with H. pylori-positive gastric juice by the PCR assay, 7 were negative by PCR assay analyzed by electrophoresis and hybridization after the completion of treatment H. pylori. However, after treatment, 3 were negative on electrophoresis but still had positive results with hybridization, indicating that a minimal number of bacilli may have still remained. Detection of H. pylori in gastric juice has potential advantages for examining H. pylori infection in the entire stomach and for follow up after treatment for the eradication of H. pylori.

Cytochrome P4502E1 (CYP2E1) activates carcinogenic N-nitrosamines, benzene, urethane and other low molecular weight compounds. This enzyme is also inducible by ethanol, and metabolizes alcohol. A restriction fragment length polymorphism (RFLP) using the Rsa I restriction enzyme has been identified in the CYP2E1 transcription regulatory region; recent studies suggest that this polymorphism may affect gene expression. We investigated the frequency of the Rsa I RFLP in a Japanese population in relation to gastric cancer and liver disease susceptibility. The frequency of this polymorphism was determined in 150 gastric cancer, 16 hepatocellular cancer, 48 liver cirrhosis and 203 benign gastric disease (controls) patients. This preliminary study shows no association of the specific genotype with gastric cancer in all subjects (odds ratio = 1.04, 95% CI = 0.74-3.08 for the heterozygote and 0.57, 95% CI = 0.22-1.50 for the homozygous rare allele, respectively). To further confirm this lack of association, an age and gender matched case-control study should be performed. Separately, there was no association of the Rsa I RFLP with hepatocellular carcinoma (p = 0.911), but there was a suggested difference between the non-viral associated liver cirrhosis patients and control patients. Thus, this polymorphism may be related to ethanol metabolism and consequential liver diseases in a Japanese population.

Endoscopic variceal ligation (EVL) has been widely adopted because it is technically easy to perform. However, it is not always possible to eradicate varices by the standard ligation method. Therefore, we examined the effectiveness of the intensive ligation method as an alternative for the eradication of varices. In applying this method, rubber bands are used to make ligations much closer to each other, than with the standard method, just above the esophago-gastric junction (EG-junction). We also compared the effectiveness of EVL in nine cases undergoing the standard ligation method with that in nine cases treated by the new intensive ligation method. With the standard ligation method, the average number of sessions was 2.2 per week, while the average number of rubber bands used was 9.6 per patient. Varices disappeared in three of nine cases. With the intensive ligation method, the number of sessions was two per week in all cases, while the average number of rubber bands was 19.9 per patient. Varices disappeared in all nine cases. Chest discomfort, as a complication, was experienced by three of nine cases in both groups. It is concluded that the intensive ligation method is a very effective means of achieving early, safe eradication of varices.

Background. Subjects with atrophic body gastritis have a high prevalence of Helicobacter pylori seropositivity and a low prevalence of H. pylori infection. Disappearance of the organism appears to correlate with the development of intestinal metaplasia. To investigate this point, intestinal metaplasia was biochemically subclassified into complete and incomplete types by the Tes-Tape method, and tissue IgA and IgG antibodies against H. pylori were measured by enzyme-linked immunosorbent assay (ELISA). Methods. Twenty-five stomachs resected for gastric cancer were examined using the Tes-Tape method. Serum H. pylori IgA and IgG antibodies and tissue IgA and IgG antibodies against H. pylori and tissue secretory IgA (sc-IgA) were examined in areas of intestinal metaplasia, nonmetaplastic gastric mucosa, and gastric carcinoma by ELISA. Results. Tissue H. pylori IgA antibody was positive in 6 of 19(32%) specimens taken from complete and 2 of 7 (29%) incomplete types of intestinal metaplasia and was positive in 6 of 14 (43%) nonmetaplastic gastric mucosa from the antrum and 14 of 23 (61%) from the body. Duodenal mucosa and cancer tissue were positive for tissue IgA antibody in 1 of 6 (17%) and 0 of 17(0%), respectively. Tissue H. pylori IgG antibody was negative in all the tissues examined. sc-IgA in the areas of intestinal metaplasia was 120 ± 65 (mean ± standard error ; ng/mg wet weight) and in the nonmetaplastic gastric mucosa was 113 ± 72, showing no difference. Positivity and negativity of serum IgA and IgG antibodies against H. pylori coincided with presence or absence of tissue IgA antibody in nonmetaplastic gastric mucosa in 15 of 19(79%) and 16 of 19 (84%) patients examined, respectively. Conclusion. Positivity rates of tissue IgA antibody against H. pylori were lower in the mucosa of intestinal metaplasia than in nonmetaplastic gastric mucosa and were negative in carcinoma. No significant difference in levels of sc-IgA between intestinal metaplasia and nonmetaplastic gastric mucosa was found. Cancer 1995 ;75 : 1472-7.

Background: Vascular endothelial growth factor (VEGF) is important in the wound healing process. We aimed to evaluate the changes of serum levels of VEGF in major surgical trauma. Patients/methods: Serum concentration of VEGF was measured by enzyme-linked immunosorbent assay in 16 patients who underwent esophagectomy for esophageal cancer. Serum samples were taken before the operation and on the 1st, 7th, 14th, 21st, 28th, 56th, and 84th postoperative days (POD). Results: Serum VEGF levels increased significantly on the 14th POD compared with the preoperative levels. Following the maximal levels on the 14th POD, serum VEGF levels decreased gradually until the 84th POD. There were no significant differences in relationships between serum levels of VEGF on the 14th POD and each of gender, age, and operative procedures. However, the increased ratio of platelet count in peripheral blood correlated with an increase in the serum VEGF level (r=0.683, p

Primary aortoenteric fistula is very rare and a highly lethal entity. It is very important not to miss a few chances to diagnose it endoscopically. We report our experience of a case of primary aortoduodenal fistula. An 80-year-old woman complained of repeated hematemesis, bloody bowel discharge, and hemorrhagic shock. An abdominal aortic aneurysm was detected by an abdominal angiography. Duodenoscopy was performed 3 and 5 days after hematemesis, showing two different patterns of endoscopic findings. Three days after hematemesis, an undermining ulcer with a dark red clot at its bottom was detected in the third part of the duodenum. Five days after hematemesis, the base of the ulcer was covered with yellowish matter on the red clot. Six days after hematemesis, aortoduodenal fistula was confirmed in the third part of the duodenum at surgery. An ulcer with yellowish matter as well as with a red clot in the third and fourth parts of the duodenum by endoscopy might be indicative of aortoduodenal fistula.

Chronic atrophic gastritis (CAG) is closely correlated with gastric cancer and is predominant in Japan. Epidemiologically, food habits are the primary factor in both CAG and gastric cancer. Two potential serum markers for CAG have recently been investigated, i.e., the concentration of serum pepsinogen (PG) and the presence of serum antibodies against Helicobacter pylori. Serum PG I and II and the PG I:PG II ratio have been reported to be useful as indicators of recurrent peptic ulcer and for screening of patients at risk from gastric cancer. In this study, we examined PG I and II in serum from 483 patients by RIA (DAINABOT), and endoscopic examination performed in the same patients before serological assay revealed CAG in 68, peptic ulcer in 91, and gastric cancer in 48. Analysis of the mean values according to patients age showed that CAG patients in their forties to eighties had low (40 ng/ml) levels of PG I, peptic ulcer patients in their teens to eighties had high (or = 70 ng/ml) levels, except for those in their seventies, and gastric cancer patients in their twenties to sixties had low (3.0) PG I:PG II ratios, except for those in their sixties. Thus serum PG assay has potential utility for detection of CAG, peptic ulcer, and gastric cancer.

A case of esophageal leiomyosarcoma, for which CT scan, endoscopic ultrasonography (EUS) and angiography were employed for preoperative diagnosis is reported. CT scan identified an exophytic mass which had no rim-enhancement in the lower end of the esophagus. EUS revealed a homogeneous mass originating from the muscularis propria. Angiography showed a mildly hypervascular tumor. Histologically, the resected specimen was a leiomyosarcoma. These results suggest that the evaluation by EUS combined with CT scan and angiography is useful in differentiating smooth muscle tumors from other submucosal tumors.

症例は胃集団検診で異常を指摘され, 精査目的に入院した47歳, 女性.胃内視鏡検査で胃体下部に山田II型の隆起性病変を認め, 表面は正常粘膜におおわれた粘膜下腫瘍であった.超音波内視鏡では胃壁第4層に一致して大きさ1.8×1.2cmの境界明瞭な腫瘤を認め, 内部エコーは固有筋層よりやや高く, 一部に低エコーの部分も伴っていた.胃内腔発育型の平滑筋芽腫を疑い, 外科治療施行.開腹時, 胃体下部に拇指頭大の腫瘤を触知, 周囲への浸潤, リンパ節の腫脹はなく, 術中迅速病理診断では良性病変と判断され, 正常粘膜を含めた腫瘍摘出術を施行した.腫瘍の大きさは2.0×2.0×1.0cmで, 組織学的には核分裂像のない楕円形細胞の充実性増殖, 核の近傍に透明帯を有する細胞の存在から, 平滑筋芽腫と診断された.術前検査として超音波内視鏡が有用であった胃平滑筋芽腫の1例を報告する.

Gardner症候群の患者に発生したdesmoid腫瘍に対して, 外科治療, 内分泌療法, 免疫療法, 放射線療法など集学的治療を行ったので報告する.患者は昭和35年生まれの男性.昭和49年, 14歳の時に, 大腸腺腫症, 下顎骨腫を指摘され, Gardner症候群と診断された.昭和59年11月, ポリープに癌化が認められ全結腸切除術施行.昭和61年5月, 腹部手術創直下のdesmoid腫瘍を摘出.昭和62年2月同腫腫瘍再発, 新たに後腹膜にもdesmoid腫瘍を認め, 同4月, 腹壁腫瘍の摘出および後腹膜腫瘍へ溶連菌製剤OK一432を局注した.術後, 抗estrogen剤のtoremifeneを投与, 画像診断にて後腹膜腫瘍の縮小を認めた.昭和63年6月, 腹壁腫瘍の再発および後腹膜腫瘍の増大を認め, 腹壁腫瘍は再摘出, 後腹膜腫瘍に対しては放射線照射を行った.治療に難渋したdesmoid腫瘍に対する集学的治療成績について報告し考察を加える

Yellowtails Seriola quingueradiata were fed on non-treated, 40°C-heated, and extruder-pro-cessed brown fish meals supplemented with vitamin and mineral mixtures and pollack liver oil for 30 days. Dietary α-tocopherol was also kept constant at a level of about 90mg per 100g. Their tissue 2-thiobarbituric acid (TBA) values and superoxide dismutase and glutathione peroxidase activities as well as the resistance of yellowtails to Streptococcus sp. were examined. Between the experimental groups of fish, no differnces were observed in the growth, the tissue enzyme activities and the resistance to Streptococcus sp.; the latter results showed that fish infected with Streptococcus sp. had strong resistance with their survival rate being high regardless of the diets used. High α-tocopherol contents and low TBA values of the diets used in the present study probably resulted in the low tissue TBA values for all the fish groups. These results also suggest that the resulting protection of various tissues of yellowtails against lipid peroxidation may be as-sociated with the possible enhancement of their biological protective ability.

The hypothalamic-pituitary-adrenal axis is an essential component for the maintenance of homeostasis following trauma. Major surgical trauma often induces overwhelming inflammatory responses leading to sepsis and organ dysfunction. This study was designed to evaluate the adrenal responses both before and after various degrees of surgical trauma and to determine the incidence of postoperative relative adrenal insufficiency resulting in the marked inflammatory response often associated with postoperative complications. Fifty-one surgical patients were divided into groups who underwent major, moderate, and minor surgeries. Before the operation and during resting conditions, a short corticotropin (ACTH) stimulation test was performed in each patient. The postoperative concentrations of serum cortisol, interleukin (IL)-6, IL-10, C-reactive protein (CRP), and plasma ACTH were measured. Fifty of 51 patients were identified as responders to ACTH. The postoperative cortisol levels were the same as those obtained by ACTH stimulation in highly and moderately stressful surgeries. The increases in postoperative IL-6 and CRP levels were greatest with major surgery, intermediate with moderate surgery, and least with minor surgery. Furthermore, plasma ACTH levels increased after major and moderate surgeries; however, there was no significant differences in postoperative serum IL-10 levels. Systemic inflammatory response syndrome (SIRS) was found in 11 of 17 patients (64.7%) who underwent major surgery and in 4 of 16 patients (25%) who underwent moderate surgery (p=0.037). The duration of SIRS was significantly longer in patients undergoing major surgery (62+/-20 hrs) than in patients undergoing moderate surgery (21+/-3 hrs, p=0.038). Postoperative complications were more frequent in patients undergoing major surgery (41.2%) than in patients undergoing moderate surgery (6.3%, p=0.039). Furthermore, there were significant differences in the length of the postoperative stay among the three groups (p

We report 3 gastric cancer patients with peritoneal dissemination who were successfully treated with weekly paclitaxel and cisplatin. The patients were 2 men and 1 woman from 57 to 70 years in age. The histological types were 2 poorly-differentiated adenocarcinomas and 1 moderately-differentiated adenocarcinoma. Intravenous infusion of PTX (80 mg/m(2)) and CDDP (25 mg/m(2)) after short premedication was continued for 3 weeks followed by 1 week rest. Ascites improved only after administration of 1 course in all patients.PTX/CDDP is thought to be an effective chemotherapy showing acceptable toxicity against advanced gastric cancer with ascites.

Video-assisted breast surgery (VABS) is a less invasive and aesthetically better option for benign and malignant breast diseases and for sentinel lymph node biopsy (SLNB). The authors have performed 150 VABS procedures since December 2001. They have examined the usefulness of three-dimensional computed tomographic (3D-CT) lymphography for detecting sentinel lymph nodes (SLNs) precisely, as well as the cosmetic and treatment results of VABS. In this study, VABS was performed with a 2.5-cm skin incision in the axilla or periareola (1 cm in the axilla for SLNB), using a retraction method, for mammary gland resection, SLNB, axillary lymph node dissection, and breast reconstruction under video assistance. On the day before the surgery, 3D-CT lymphography was performed to mark SLN on the skin. Above the tumor and near the areola, 2 ml of Iopamiron 300 was injected subcutaneously. A 16-channnel multidetector-row helical CT scan image was taken after 1 min and reconstructed to produce a 3D image. Sentinel lymph node biopsy was performed by the VABS technique using the Visiport. The VABS procedure was performed for 19 benign and 131 malignant diseases, and 115 SLNBs (74 with 3D-CT) were performed. The SLNs were shown precisely by 3D-CT lymphography, as proved by a case of lymph node metastasis, in which accurate relationships between lymph ducts and SLNs were shown. These were classified into four patterns: a single duct to single node (40 cases), multiple ducts to a single node (13 cases), a single duct to multiple nodes (1 case), and multiple ducts to multiple nodes (12 cases). The SLNB procedure can be performed safely by 3D-CT lymphography and less invasively by VABS. The findings show that 3D-CT lymphography is useful for performing precise SLNB using VABS.

Lumican is a member of a small leucine-rich proteoglycan family, and it is reportedly overexpressed in human breast cancer. The expression of lumican in the extracellular matrix in breast cancer is associated with a high tumor grade, low estrogen receptor levels and young age. Lumican expression has been previously reported in colorectal cancer, but the role of lumican in the tumor is not well understood. In this study, we examined the expression and role of lumican in advanced colorectal cancer. Immunohistochemical staining was performed on 158 patients who underwent curative surgery for advanced colorectal cancer with lymph node metastasis. In the normal colorectal tissues, lumican immunoreactivity was observed in the fibroblasts and neural cells, but not in the colorectal epithelial cells. Lumican was localized in the cytoplasm of the cancer cells and its overexpression was detected in 99 of the 158 (62.7%) colorectal cancer patients. Clinicopathologically, there was no association of lumican expression with age, sex, histological typing, or venous and lymphatic invasion. However, lumican expression tended to correlate with the spread of lymph node metastasis and the depth of tumor invasion (p=0.136 and 0.135, respectively). Furthermore, the survival rate was significantly lower in patients with a high lumican expression level than in those with a low lumican expression level (p=0.048). These results indicate that lumican expression is a potential prognostic factor in patients with advanced colorectal cancer with nodal metastasis.

5-Fluorouracil (5-FU) and its derivatives are widely known as some of the most commonly prescribed anticancer drugs, especially for gastrointestinal cancer. Orotate phosphoribosyl transferase (OPRT), dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) are initial key enzymes in the 5-FU metabolic pathway. The activities of these enzymes may have the potential to affect the chemosensitivity of 5-FU.This study was designed to investigate the effect of OPRT, DPD and TS in sensitivity to 5-FU.We measured OPRT, DPD and TS activities in 11 colonic cancer tissues. The Collagen Gel Droplet Embedded Culture Drug Sensitivity Test (CD-DST) was used in an in vitro chemosensitivity assay. In these samples, the correlation between sensitivity to 5-FU and enzyme activities was investigated.There were no correlations among OPRT, TS activities and sensitivity to 5-FU. In contrast, there was a significant inverse correlation (r=-0.738) between DPD activity and 5-FU sensitivity. With regression analysis, the coefficient of determination of the activity of the three enzymes versus the sensitivity to 5-FU was 0.61.Though measuring OPRT, DPD, TS activities is valuable for prediction of sensitivity to 5-FU, DPD is considered to be the most important predictive factor of 5-FU sensitivity. To improve its accuracy, the finding of a fourth factor such as P-glycoprotein and multidrug resistance-associated proteins (MRP), to be added to OPRT, DPD and TS, is desired.

Orotate Phosphoribosyl Transferase (OPRT), Dihydropyrimidine dehydrogenase (DPD) and Thymidylate synthase (TS) are initial key enzymes in the 5-FU metabolic pathway. In this study, we measured the activities of OPRT, DPD and TS. We also investigated the correlation between these 3 enzymatic activities and the clinical pathologic factors (Histological typing, extent of tumor invasion,extent of metastasis to the lymph nodes,stage, lymphatic invasion and venous invasion). We had surveyed 79 cases of colorectal cancers surgically removed. Poorly-differentiated adenocarcinoma showed a tendency to lower OPRT and higher DPD, as compared to moderately or well-differentiated adenocarcinomas. In case with metastasis to lymph nodes, OPRT showed a tendency to lower activities, but a significant difference was not noticed. TS showed no relation to any of these pathologic factors. In each application of 5-FU, measuring the activities of these three enzymes is important for estimation of the antitumoral effect. With poorly-differentiated adenocarcinoma, it is estimated that many cases would show high DPD and if the enzyme activities can not be measured, so administration of TS-1, which includes DPD inhibitor, may be considered.