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It is relatively easy to detect early gastric cancer in the vicinity of the pylorous ring or invading the duodenum by a use of endoscopy, but the satisfactory precise precise diagnosis of the depth and extent of tumor invasion has not been established as yet. This study was designed to elucidate some problems in the diagnosing ability of gastric endoscopy and EUS for such early gastric cancers. Subjects were 26 patients undergone gastrectomy for early gastric caner in a recent 5-year period, consisting of 21 patients whose center of the lesion situated within 2cm from the pylorous ring and five patients whose tumors invaded the duodenum. The correct diagnosing rate of depth of tumor invasion by gastric endoscopy was 69.2•(18/26) in all patients. On the other hand, it was 57.1•(12/21) in 21 patients who underwent EUS. There was a tendency for EUS to give a read-out of the depth which was deeper than actual depth. Furthermore, early gastric cancer invading the duodenum present difficulty in determining the extent by gastric endoscopy especially on the duodenal side of the lesion. It is probably better that doctors use high frequency EUS equipments.

We report a case of gastric cancer with high serum levels of IL-6 and G-CSF. A 76-year-old man was admitted to the hospital presented with high grade fever. Although biochemical tests indicated an inflammatory reaction (WBC 11, 800/mm3, CRP 13.9mg/dl) and consequently infection, no other evidence of infection was odtained upon further clinical examinations. Furthermore, a possibility of autoimmune disease was ruled out based on the laboratory data and physical findings. Endoscopic examination, prompted by occult blood in the stool, identified two separate gastric cancer lesions in the antrum and body of the stomach. The fever was resistant to various antibiotics, but administration of Naproxen at a dose of 600mg per day p.o. was effective. We reasoned that the fever was in some way associated with the gastric cancer. After a distal partial gastrectomy was performed, a dramatic crisis, involving rapid reduction of fever and a simultaneous decrease in the levels of IL-6 and G-CSF, occurred. Immunohistochemical stainings for both IL-6 and G-CSF on surgical specimens were negative. We believe that the high serum IL-6 and G-CSF levels were the result of immunoreaction to gastric cancer rather than direct secretion from the cancer cells.

The c-erbB-2 protooncogene encodes a possible growth factor receptor. This gene has been studied as to whether it can be regarded as a prognostic indicator in human breast carcinoma. As amplification and overexpression of the gene have been reported in several adenocarcinomas, 24 specimens of human gastric cancers were examined by immunohistochemical staining (24 cases), by Southern blotting (23/24) and by Northern blotting (16/24). Amplification of the gene was detected in two moderately differentiated tubular adenocarcinomas (8.7%), and overexpression of c-erbB-2 m-RNA was detected in three moderately differentiated tubular adenocarcinomas (18.8%). By immunohistochemical staining of paraffin-embedded tissues using a polyclonal antibody to c-erbB-2 gene products, the cell membrane was stained positively in three cases of gastric cancers which overexpressed c-erbB-2 mRNA. Peritoneal metastases were found in six gastric cancers, including two moderately differentiated tubular adenocarcinomas in which amplification of c-erbB-2 occurred. These results suggest that amplification and overexpression of c-erbB-2 may be correlated with metastases in differentiated adenocarcinoma of the stomach.

During the period from August 1974 to December 1990, 115 cases of gastric, 97 of duodenal and 23 of combined gastroduodenal ulcer were operated on for gastroduodenal ulcer at the department. Among these cases, operation for perforation was carried out in 8 of gastric, 37 of duodenal and 3 of combined gastroduodenal ulcer. The incidences of perforation were 7.0%, 38.1% and 13.0%, respectively. Since all 3 cases of combined gastroduodenal ulcer developed perforation in the duodenal ulcer, these cases were included in the duodenal perforation group. The ratio of perforation in gastric to duodenal ulcer was 1:5, indicating that the majority of perforation occurred in the duodenal ulcer. The male to female ratio was 6:1, showing a high prevalence of males. Young men were more likely to have duodenal perforation than gastric perforation. The incidence of free air on the plain X-ray film was 75.0% in gastric perforation and 97.5% in duodenal ones. Epigastric sudden pain occurred in 50.5% of gastric and 87.5% of duodenal perforation cases, respectively. Anamnesis of ulcer disease was recognized in 62.5% of perforated gastric ulcer and 47.5% in perforated duodenal ulcer cases. The overall mortality rate was 8.3% (4 cases).

症例は75歳,女性.主訴は下血で,約5カ月前より排便時に鮮血性の出血を認めた,近医を受診し,直腸癌の診断で当科紹介入院となった.入院時,血液・生化学検査では軽度の貧血を認めるのみであった.注腸検査で,肛門管に直径2cmと3cmのそれぞれ独立した腫瘤を認めた.内視鏡検査では,肛門管に表面不整を伴う白色の腫瘍を5時と9時に認めた.生検で扁平上皮癌であった.手術は腹会陰式直腸切断術,リンパ節郭清を施行した.切除標本では,歯状線直上にそれぞれ独立した腫瘍を認めた.病理組織学的検査では両者とも類基底細胞癌であり,2つの腫瘍間に組織学的連続性を認めなかった.