[Surgical treatment of cancer of the digestive organs]

Recently the surgical treatment for cancer of digestive organ has made remarkable progress. This development depends on the progress of diagnosis, instrument, operation procedure and management. I will state on the principle of oncological surgery, stage classification, minor surgery, major surgery and multidisciplinary treatment. And I will mention about latest trend of surgical treatment for cancer.

Effect of x-ray irradiation on lipid peroxide levels in the rat submandibular gland

We examined the effect of local x-ray irradiation on the changes in the lipid peroxide level in submandibular gland, liver, and blood plasma. Rats five weeks of age received a single low dose of 3 Gy x-ray irradiation to their neck regions. The lipid peroxide level in the submandibular gland was significantly enhanced at seven days after irradiation, as was the level in the blood plasma at two hours, seven and 14 days after irradiation. The lipid peroxide level in the liver decreased, as compared with levels in the controls. There was a slight tendency for acinar cells of the submandibular gland to show pyknosis and anomalous nuclei within three days after irradiation. These results suggest that radiation injury results in an elevation of the lipid peroxides in the submandibular gland, and an increased level in the blood.

[Childhood liposarcoma of the eyelid--a case report]

An 11-year-old girl noted a small mass on the left upper eyelid. The tumor was excised and diagnosed as round cell-type liposarcoma. In spite of intensive multimodal therapy, the tumor tended to recur, metastasizing to the central nervous system and soft tissues. The patient died of progressive disease three years after diagnosis. Features unique to this case include the ophthalmological primary site, the age at onset, the histological subtype and the mode of metastasis.

[Thyroid nodules; evaluation of malignancy by ultrasonography]

Preoperative ultrasonic examination was correlated to final pathological diagnosis in 102 cases which underwent thyroidectomy in our clinic from 1979 to May 1985. Preoperative ultrasonic diagnosis was as follows: Sensitivity was 78% (45/58 cases), and specificity was 86% (38/44 cases). Four factors in ultrasonic image were considered: Shape, boundary, internal echo and margin were featured, and correlated to malignancy in 75 cases with mainly solid nodules. Among 34 nodules with irregular shape, 33 (97%) were pathologically malignant and 40 of 42 (95%) with rugged boundary were also malignant. Whether internal echo was even or not could not be used as a diagnostic criteria. Similarly, whether a nodule had well defined margin or not was found not to be a significant criteria in order to differentiate malignant from benign lesions. In 15 of 34 cases with lymph node metastases, metastatic lymph nodes were detected by ultrasonography. Lymph node metastases must be also evaluated by ultrasonography preoperatively in thyroid diseases. Each of these factors must be considered individually in the diagnosis of thyroid nodules. By evaluation of the ultrasonography findings the pathological characteristics may be inferred, and consequently being possible to reach a correct diagnosis.

[Effects of cis-DDP in children with refractory malignant tumors]

Eighteen children with refractory malignant tumors were treated with cis-DDP. They included 10 neuroblastomas, 2 rhabdomyosarcomas, and one each of hepatoblastoma, yolk sac tumor, osteosarcoma and pinealoma. Of 7 cases treated only with cis-DDP, 2 were NC, 6 PD and none were CR or PR. Of 11 cases treated with cis-DDP combined with other agents, 7 were PR, 2 NC, 2 PD and none were CR. The major side effect of cis-DDP was renal toxicity, but this was not serious and only transient. Three cases were treated with the continuous intra-arterial infusion method. These included 2 neuroblastomas and one yolk sac tumor. This treatment was therefore highly effective for children with malignant tumors, and few side effects were observed.

[Treatment of gastric cancer based on the pathological and biophysiological aspects of cancer]

Spread of the gastric cancer is multifarious according to its pathological and biophysiological characteristics. The therapeutic strategy was reviewed by the analysis of more than 8.000 cases of gastric cancer treated at Cancer Institute Hospital. Main type of recurrence in early stage cancer was, though seldom, the hematogenous metastasis to the liver. On the other hand, in the advanced cases, macroscopically localized, and histologically well differentiated tumor type easily adhered and invaded to the adjacent organs and structures, and infiltrating and undifferentiated tumor type tended to cause peritoneal dissemination. Lymph node spread was observed in any tumor type, but frequently observed in intermediate type. Invasion to the adjacent organs and limited lymphatic spread can be controlled by wide combined resection of adjacent organs, and extended lymphadenectomy. However, hematogenous metastasis and peritoneal dissemination are difficult to be controlled by surgical intervention. Thus, minor surgery can be directed for small early stage cancer under strict criteria, and wide and extended resection for localized type, and combination of surgery and adjuvant chemotherapy for intermediate and infiltrating tumor types advancing more than stage II.

[The accuracy of frozen sections in the diagnoses of breast lesions]

To evaluate the accuracy in diagnosing breast lesions by frozen sections, 657 consecutive diagnostic biopsies seen during 1982 were reviewed. Of 559 lesions considered benign at frozen sections, 558 were also benign in paraffin sections, the remaining one being a papillary carcinoma (i.e. 1/559 or 0.2% false negative). All 78 cases diagnosed as malignant in frozen sections were also malignant in paraffin sections (i.e. 0% false positive). Of the 20 doubtful cases, in frozen sections, 15 showed a papillary lesions; 7 of them were malignant in paraffin sections and the rest 13 benign. It is concluded that the frozen sections are usefull in the diagnoses of mammary disorders except for those cases with papillary tumors.

Preferential rearrangement of the immunoglobulin kappa chain joining region J kappa 1 and J kappa 2 segments in mouse spleen DNA

The V kappa-KpnI family, which constitutes approximately equal to 36% of mouse kappa chain variable region gene (V kappa) segments, conserves the Kpn I site (G-G-T-A-C-C) at the position corresponding to residues 35-37. Using this cleavage site, we were able to assess the relative recombination frequency of the kappa chain joining region gene (J kappa) segments in mouse spleen DNA. The J kappa 1 and J kappa 2 segments were used 2- to 5-fold more frequently than were the J kappa 4 and J kappa 5 segments. The J kappa 3 segment was shown to be incapable of recombining with the V kappa segment. The relative recombination frequency of the J kappa segments did not change significantly by lipopolysaccharide stimulation of normal mouse spleens. The relative frequency of the J kappa usage was unaltered in immune disorders such as in nude (nu/nu), MRL (lpr/lpr), and BXSB mice. Seven V kappa-KpnI-J kappa 1 clones were isolated, and their nucleotide sequences were determined. Two of them were derived from the identical germ-line V kappa segment but differed in the nucleotide sequence of the V-J junction. The maximal number of V kappa germ-line segments was estimated to be less than 300 by statistical calculation.

[Influence of total parenteral nutrition (TPN) on nutritional incidences in patients with recurrent cancer]

The influence of total parenteral nutrition (TPN) on nutritional assessment of patients with recurrent cancer was studied. One hundred forty-six patients with recurrent gastric, colorectal and breast cancer who have been admitted to our hospital during the past five years were surveyed. Serum albumin and cholinesterase levels on admission in the gastric and breast cancer patients who died in the hospital were considerably lower than those of the patients who recovered sufficiently to be discharged from the hospital. The patients with recurrent gastric cancer who received TPN for more than a week were also analyzed. It was shown that those whose levels of serum total protein and albumin did not respond favorably to TPN were the patients with shortest survival. Therefore, by checking the response to the administration of TPN, it seems to be possible to predict the patient's prognosis.

Advanced neuroblastoma and disseminated intravascular coagulation: report of six cases

We have experienced 30 patients with neuroblastoma since 1975. Disseminated intravascular coagulation (DIC) developed in six of these patients. They were all in stage IV, namely disseminated neuroblastoma. These six cases with DIC proved that some advanced neuroblastomas have the potential to cause coagulopathy in the process of the disease. The plasma concentration of heparin was measured in some patients who were treated with heparin. The data revealed that the conventionally used intravenous heparin dose is not appropriate in the case of DIC. Effective treatment requires monitoring of the plasma concentration of heparin.

Low mobility T cells in the peripheral blood of cancer patients: surface modification and mobility

To elucidate how low-mobility T cells emerge in the peripheral blood of cancer patients, lymphocytes from normal individuals were treated with cancer patients' plasma, immunosuppressive (IS) substance with or without interleukin-2, or neuraminidase. A delay in cell mobility was induced by IS substance and neuraminidase treatments, which degrade the cell surface charge. Compared to the normal mobility pattern of lymphocytes, patterns induced by these treatments were characterized by a general shift of the fast cell peak to the left side. These patterns were different from those of cancer patients in terms of the inverse relationship between slow and fast peaks. These results indicate that, though humoral factors in the peripheral blood of cancer patients take a partial role, other mechanisms might operate to induce the characteristic mobility pattern of lymphocytes. One of the possibilities, the emerging of a special T cell subset recruited from the thymus, is discussed.

[Effect of cisplatin (CDDP) against peritonitis carcinomatosa in nude mice inoculated intraperitoneally with human gastric cancer]

Development of effective chemotherapy for patients with peritonitis carcinomatosa is considered to be very important in cancer management. In this study, intraperitoneal injection (ip) of cisdichlorodiammineplatinum (II) (CDDP, cisplatin) together with subcutaneous injection (sc) of sodium thiosulfate (STS), abbreviated as 2-channel chemotherapy, were discussed with regard to its safety and efficacy on peritonitis carcinomatosa using nude mice inoculated intraperitoneally with SCK-8 tumor cells derived from human gastric cancer. A single ip lethal dose (16 mg/kg) of CDDP reproducibly caused weight loss in nude mice and killed 100% of the nude mice by day 5 after injection. However, sc of STS (1,200 mg/kg) protected nude mice against a lethal dose of CDDP, and reduced CDDP-induced weight loss. Two-channel chemotherapy (CDDP 16 mg/kg ip + STS 1200 mg/kg sc) using nude mice with advanced peritonitis carcinomatosa produced a 45% increase of life span with a survival of 74.6 +/- 6.2 days (n = 8), compared with control nude mice with peritonitis carcinomatosa surviving 51.5 +/- 13.3 days (n = 11). Therefore, it is conceivable that 2-channel chemotherapy can be applied to the management of cancer patients with peritonitis carcinomatosa.

[Cancer and the lymph nodes]

Lymph node metastasis of cancer has great significance with respect to its circumstances, diagnosis, treatment and prognosis. In recent years, especially, we have experienced advances in the field of lymphatic circulation and the role played by lymph nodes in immunological surveillance. The various associated problems and the progress which has been made with regard to cancer and lymph nodes are discussed.

Eosinophilic gastroenteritis. Immunohistochemical evidence for IgE mast cell-mediated allergy

A surgical case of a middle-aged Japanese with eosinophilic gastroenteritis is described. This 50-year-old man presented protein-losing gastroenteropathy, iron-deficiency anemia, and marked elevation of serum IgE, in whom the lesion formed a diffuse thickening of almost the entire portion of the stomach. Microscopically, there was an intense infiltration of eosinophils throughout the whole thickness of the gastric wall, interspersed with plasma cells and lymphocytes. On the affected area, an increased number of IgE-positive plasma cells and surface IgE-positive mast cells, some of which are degranulated, were identified. These immunohistochemical findings provide a strong evidence for IgE mast cell-mediated allergy concerning this disorder.

Barium peritonitis. Report of a case and review of the literature

A case of generalized peritonitis, secondary to a perforation of the rectosigmoid colon during barium-enema roentgenography, is presented. The patient required immediate surgical intervention with the prime importance of the treatment being removal of as much of the contaminating materials as possible. This was done successfully with irrigation and wiping, using urokinase solution. Peritoneal lavage with urokinase solution was also carried out in the early postoperative period. Fluid replacement with careful monitoring of fluid and electrolyte balance is essential before, during, and after the surgical procedure. Adequate antibiotic therapy and careful respiratory and nutritional support are also important.

The influence of family history of cancer, irradiation and anticancer medication (mitomycin C), on the occurrence of multiple primary neoplasms with breast cancer--statistical analysis by the person-year method

The influence of family history of cancer, radiation therapy and anticancer drug therapy (mitomycin C) on the occurrence of multiple primary neoplasms, following treatment of a first primary cancer of the breast, was analyzed by the person-year method in 1,359 patients, in Japan. During 14,371.8 person-years of observation, 111 multiple primary neoplasms including bilateral breast cancers were found in 109 patients. The incidence rate of multiple primary neoplasms were 0.00772 per person-year. The incidence in patients with a family history of cancer was 1.29 times greater than that in patients without such a family history, and the incidence in patients with a family history of breast cancer was about three times greater than that in those without it (p less than 0.01). Radiation therapy raised the occurrence of subsequent primary neoplasms 1.28-fold (or 1.62 fold after 5 years), and mitomycin C (a total dose of 0.8 mg/kg) therapy caused no increase in the occurrence of subsequent primary cancers, after an observation of 10 years or so.

[Effect of cis-platinum in neuroblastoma]

We treated six children with neuroblastomas. They were all refractory to conventional chemotherapy or at an advanced stage when diagnosed. Patients were four males and two females aged 1 to 7 years old, with a mean age of 3.7 years. Total cis-DDP dose ranged from 60 mg/m2 to 720 mg/m2, with a median dose of 240 mg/m2, and a mean dose of 260 mg/m2. Of the six children, two were PR, three were PD, and one was NC. Of three non-responses, two cases were clinically improved. Two cases had renal dysfunction but this improved within 3 weeks. It is said that cis-DDP induces irreversible renal damage, especially tubular necrosis. Our two cases had progressively decreased creatinine clearance, though values of BUN and creatinine were normal. Bone marrow suppression was mild, so there was no need to discontinue or modify the cis-DDP chemotherapy schedules. Two hypo-magnesemia were found, both cases being asymptomatic. Transient liver dysfunction occurred in one child, and nausea and vomiting were observed in almost all cases.