A novel core protein as well as polymorphic epithelial mucin carry peanut agglutinin binding sites in human gastric carcinoma cells: sequence analysis and examination of gene expression

The peanut agglutinin (PNA)-binding site is protein-bound Gal beta 1-->3GalNAc, and is a tumor-associated carbohydrate marker expressed in many human carcinomas. PNA-binding glycoproteins isolated from KATO-III human gastric carcinoma cells were deglycosylated by trifluoromethanesulfonic acid, and rabbit antibodies against the core proteins were used to screen a lambda gt11 expression library constructed from these cells. Two different core proteins were identified by this approach. One was polymorphic epithelial mucin (PEM), initially found in breast carcinomas. PEM mRNA was expressed in normal tissues of the stomach, colon, and lung, but not in the small intestine, thyroid, and spleen. High levels of PEM mRNA were detected in some nude mouse-transplanted carcinomas, i.e. colorectal, pancreatic, stomach, and lung carcinomas. The other core protein was a novel one called MGC-24, which has a molecular mass of 24 kDa, is rich in hydroxyl amino acids and cysteine, and lacks repeating motifs. The mature MGC-24 glycoprotein behaved as a high-molecular-mass one upon SDS-polyacrylamide gel electrophoresis even after neuraminidase treatment. Treatment with endo-alpha-N-acetylgalactosaminidase in the absence of neuraminidase significantly changed the staining pattern by anti-MGC-24, confirming that MGC-24 carried PNA-binding sites. MGC-24 mRNA was intensely expressed in normal tissues of the colon, small intestine and thyroid, and in some nude mouse-transplanted colorectal and pancreatic adenocarcinomas.

[Histopathological features of the lymph node metastases in patients with thoracic esophageal cancer]

Histopathological features of the lymph node involvement were studied in 104 patients with thoracic esophageal cancer who underwent subtotal esophagectomy combined with extended radical lymph adenectomy in cervicothoracoabdominal region. Metastatic involvement was found in a total number of 503 lymph nodes from 73 patients by histologic examination. The mean of long and short diameter was found to be less than 5mm in 125 (24.9%) of these 503 nodes. The involved area on the section was less than one third in 149 nodes (29.6%), and was significantly smaller in mediastinal lymph nodes than those in cervical or abdominal ones. Sixty-seven (13.3%) of 503 nodes were partially invaded by micrometastasis of 1mm or less in diameter. Micrometastasis also more frequently occurred in mediastinal nodes with a statistically significant difference. Extranodal proliferation (ENP) of cancer cells was found in 106 nodes (21.1%), and extranodal lymphatic and/or blood vessel invasion (ENly, v) was also recognized in 60 nodes (11.9%). Micrometastasis and ENP with or without ENly, v were found in 24 (32.9%) and 29 (39.7%) of 73 patients with positive lymph node metastasis, respectively. Postoperative survival rate in patients with micrometastasis and/or ENP with or without ENly, v was inferior to that in patients with neither of them.

[A successfully treated case of thoracic meningocele with von Recklinghausen's disease]

Intrathoracic meningocele is an uncommon disease. Only 95 cases in the foreign literature and 13 cases in Japanese literature have been reported since Phol Meningocele occurs most frequently in the sacral and lumbar spinal regions. In this present paper, an 18-year-old female with intrathoracic meningocele associated with neurofibromatosis is described. The patient was admitted to our Surgical Clinic with a complaint of constrictive pain in the upper chest. The meningocele was diagnosed preoperatively and resected surgically by left thoracotomy. The patient has been followed up to for six years without any evidences of local recurrence. However, she recently complains of headache and weakened eyesight because of pituitary tumor, the operative indication of which is now discussed.

[Postoperative changes in acute phase protein in patients with esophageal cancer]

Thirty-three patients with esophageal cancer were studied to assess the relationship between nutritional state and the acute phase protein responses. Blood samples taken preoperatively and days 1, 4, 7 and 14 after operation were analyzed for C-reactive protein, fibrinogen, alpha 1-antitrypsin, alpha 1-acid glycoprotein and haptoglobin. Significant Spearman's coefficients were found between percent of ideal body weight (IBW) and alpha 1-acid glycoprotein (r = -0.42), between prealbumin and alpha 1-anti-trypsin (r = -0.55), and between retinol-binding protein and alpha 1-antitrypsin (r = -0.51). Postoperatively, the levels of C-reactive protein, fibrinogen, alpha 1-anti-trypsin and alpha 1-acid glycoprotein were significantly lower in the poorly nourished group than in the other groups. The changes of acute phase proteins in the immediate postoperative period were affected by the preoperative nutritional state, and were less marked in the poorly nourished patients. Between two groups of patients in whom lymph node dissection was carried out in 2 or 3 areas, no significant differences were observed in the acute phase protein responses postoperatively. The measurement of acute phase proteins is very important in assessing the body defense capacity of the patient, but it should be noted that the changes may be affected by several factors including malnutrition.

Effect of a dihydropyridine analogue, 2-[benzyl(phenyl)amino]ethyl 1,4-dihydro-2,6-dimethyl-5-(5,5-dimethyl-2-oxo- 1,3,2-dioxaphosphorinan-2-yl)-1-(2-morpholinoethyl)-4-(3-nitrophenyl)-3 -pyridinecarboxylate on reversing in vivo resistance of tumor cells to adriamycin

A newly synthesized dihydropyridine analogue, 2-[benzyl(phenyl)-amino]ethyl 1,4-dihydro-2,6-dimethyl-5-(5,5-dimethyl-2-oxo-1,3,2-dioxaphosphorina n-2-yl)-1- (2-morpholinoethyl)-4-(3-nitrophenyl)-3-pyridinecarboxylate (PAK-200), at 5 microM inhibited the efflux of [3H]vincristine from KB-C2 cells and increased the accumulation of [3H]vincristine in KB-C2 cells to a level similar to that in KB-3-1 cells. PAK-200 inhibited the photoaffinity labeling of P-glycoprotein in KB-C2 membranes by [3H]azidopine. At 5 microM, PAK-200 enhanced the cytotoxic effect of Adriamycin on drug-sensitive KB-3-1 cells, multidrug-resistant KB-8-5 cells, and two human colorectal carcinoma tumor lines, COK-28LN and COK-36LN, by factors of 2, 5, 2, and 3 times, respectively. The calcium antagonistic activity of PAK-200 was about 1000 and 5 times lower than that of another dihydropyridine analogue, nicardipine, and of verapamil, respectively. PAK-200 in combination with Adriamycin completely suppressed the growth of KB-3-1 and COK-36LN and partially suppressed the growth of KB-8-5 but had no significant effect on COK-28LN cells xenografted in nude mice. The level of MDR1 expression of COK-36LN was about 3 times higher than that of COK-28LN, but lower than that of KB-8-5 cells. These results suggest that the interaction of PAK-200 with P-glycoprotein may be partly correlated with the enhancement of the antitumor effect of Adriamycin on xenografted KB-8-5 and COK-36LN cells in nude mice.

Carbohydrate profiles shown by a lectin and a monoclonal antibody correlate with metastatic potential and prognosis of human lung carcinomas

The expression of two carbohydrate markers--namely, 4C9 antigen, which is an Lex antigen, and the Dolichos biflorus agglutinin (DBA) binding site, which is an N-acetylgalactosamine marker--was examined histochemically in tumors and adjacent nontumorous tissues of 102 cases of human lung carcinomas. In nontumorous tissues, the DBA binding site was expressed more frequently than 4C9 antigen, and the DBA binding site had a tendency to be expressed more significantly than in tumor cells. Adenocarcinomas and well-differentiated tumors had a tendency to more cell surface staining. Patients with tumors that expressed DBA binding sites but not 4C9 antigen (4C9-, DBA+) had fewer metastasis and significantly better prognoses than patients with tumors of other carbohydrate profiles. Better prognosis of patients with 4C9-, DBA+ tumors was observed in those with blood group A antigen and those without it, and the better prognosis also was observed in patients with Stage I and IIIA disease.

Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer

Endorectal ultrasonography (ERUS) with a flexible-type radial scanner (Aloka Co. Ltd., Tokyo, Japan; 7.5 MHz) was applied to 120 patients with rectal cancer for the assessment of wall invasion and pararectal lymph node metastasis. Normal rectal wall was described as a five- or seven-layer structure excluding the lowest part within 3 cm from the anal verge. Loss of normal layers basically indicated the existence of cancer invasion. According to UICC classification, we divided the depth of wall invasion into four ultrasonographic levels (uT1-uT4), and results were correlated with histopathologic findings. Overall accuracy of the assessment was 92.0 percent (103/112). Overestimation occurred in 5 of 60 cases with T3 cancer (8.3 percent), and underestimation occurred in 1 of 19 cases with T2 cancer (5.3 percent) and 3 of 60 cases with T3 cancer (5 percent). Inflammatory cell infiltration was found around the cancer in a considerable number of cases. However, the assessment of wall invasion was hardly affected in our hands. Because the muscularis propria of the rectal wall was often recognized as a three-layer structure, uT2 cancer was subdivided into three subgroups of uPM1, uPM2, and uPM3. The assessment of invasion of sublayers in muscularis propria was possible in 14 of 19 cases (73.7 percent), and correct assessment was achieved in 57 percent of the cases. The ultrasonographic demonstration of pararectal lymph nodes was studied on 98 patients. No swollen lymph nodes were detected ultrasonographically in 35 of 98 cases (35.7 percent), but cancer metastasis was found histopathologically in 5 of these 35 cases (14.3 percent). The metastasis was observed more frequently in lymph nodes with a diameter of more than 5 mm (53.8 percent) and in those with a well-defined boundary and with an uneven and markedly hypoechoic pattern (72.3 percent). Although unable to detect minimal cancer foci. ERUS was considered a very useful tool for the assessment of the depth of cancer invasion in the rectal wall and pararectal lymph node metastasis.

[A case of pulmonary blastoma]

A 45-year-old male with pulmonary blastoma was described. The patient suffered from headache and gait disturbance, and was diagnosed metastatic brain tumor. The histopathology of the removed tumor indicated metastasis from pulmonary blastoma. The pulmonary tumor, which had been detected on the chest x-ray film but misdiagnosed tuberculous lesion, was subsequently diagnosed pulmonary blastoma by TBLB. The patient underwent left upper lobectomy with mediastinal lymph node dissection, but died 12 months after the operation. To our knowledge, only 54 cases with pulmonary blastoma have hitherto been reported in the Japanese literature.

Early postoperative chemotherapy following noncurative resection for patients with advanced gastric cancer

We studied the effect of early postoperative chemotherapy, including 5-fluorouracil (5-FU) for 5 days for patients with gastric cancer following noncurative resection. The study was prospectively randomised and controlled, and 162 (87.1%) of 186 were eligible candidates for statistical assessment. Patients randomised to group A received therapy that is used widely to treat patients with gastric cancer in Japan; mitomycin C (MMC), OK-432, UFT and PSK. Patients randomised to group B received the same drugs given to group A plus 5-FU bolus injections for 5 days, beginning on postoperative day 2. There were no differences in prognostic factors and doses of the drugs prescribed, except for 5-FU. There was no difference in the toxicity rate between the groups. Generalised Wilcoxon test revealed a P value of 0.169, and the 50% survival rate improved 1.4-fold in patients with gastric cancer treated with early postoperative chemotherapy of MMC, OK-432 plus 5-FU injection.

[Evaluation of nutritional status in patients with esophageal cancer by measurement of sternocleidomastoid, rectus abdominis and quadriceps muscles on ultrasound imaging]

To assess the nutritional status of the patients with esophageal cancer, we measured the areas of sternocleidomastoid and rectus abdominis muscles (SMA, RAMA) on real time ultrasound imaging and calculated muscle index (MI = (SMA+RAMA/Height)). Eighty-three patients with esophageal cancer were included in the present study. Preoperatively, significant Spearman's coefficients were found between MI and the percentage of standard arm circumference (R = 0.52) and between MI and the percentage of standard arm muscle circumference (R = 0.51). Postoperatively, patients with wide muscle area showed high values of prealbumin, transferrin and fibronectin. To study the changes after surgery, we also measured the area of quadriceps muscle in patients with esophageal cancer. The areas of quadriceps muscle in patients with dysphagia were much diminished than in those without dysphagia. Measurement of areas of muscles such as SMA, RAMA and quadriceps muscle was proved to be a useful procedure in evaluating the nutritional status of patients with esophageal cancer.

Significance of lymph nodal metastases in treatment of esophagogastric adenocarcinoma

Between 1973 and 1990, 104 patients with adenocarcinoma of the esophagogastric junction (EGJ) (i.e., primary tumor within 2-3cm of and including the EGJ) were operated upon. Preoperatively, all were deemed potentially resectable. In 70, the esophagogastrectomy was combined with en-bloc resection, that is, wide excision of the primary mass in conjunction with radical lymph node dissection of the posterior mediastinum and upper abdomen. Postoperative staging was done using the WNM system [i.e., wall penetration (W), lymph node involvement (N), and systemic metastases (M)]. Sixty-four patients or 62% had lymph nodes positive for metastases and these neoplastic nodes were most common in the areas between the lower mediastinum and the celiac axis. Of the 70 patients undergoing radical en-bloc resection, paracardiac lymph nodes had the highest rate of metastatic involvement (40%) while gastric lesser curvature lymph nodes had 29%, and distal splenic/pancreatic lymph nodes 11%. Overall, the frequency of intrathoracic lymph nodal metastases was 7%. Those patients who had intrathoracic lymph nodal metastasis also had intraabdominal lymph nodal secondary tumor involvement. Among postoperative survivors, the percent of 5 year survival with N0 (no positive node) and N1 (1 to 3 positive nodes) stage of disease was 38.6% and 28.9%, respectively, compared to only 11.5% in those with N2 (4 or more positive nodes) staging. Because long-term survival is dismal in patients with multiple lymph nodal metastasis, preoperative and intraoperative staging is desirable to avoid morbidity of radical resection for EGJ adenocarcinomas. With less than 3 positive nodes, en bloc resection is worthwhile.

Monoclonal antibodies against a human gastric cancer cell line with lung metastatic potential in nude mice define antigens with different expression between the primary and metastatic liver lesions

SCK-29 is a tumor cell line derived from human gastric adenocarcinoma with the feature of producing lung metastases when xenografted in nude mice. Monoclonal antibodies were produced against SCK-29 tumor cells or their glycoproteins prepared by affinity chromatography on a lectin-agarose column. Five antigens defined by the monoclonal antibodies MG-1 to MG-5 were expressed in a large number of gastric or colonic adenocarcinomas. Among the antigens, MG-1 and MG-3 proved to be tumor-associated, since they were detected only occasionally in normal tissues. MG-5 antigen was often detected in normal gastric mucosa but not in other tissues. The degree of expression of MG-1. MG-3 and MG-5 antigens differed considerably in metastatic lesions. In metastatic liver lesions of gastric adenocarcinoma, expression of these MG antigens was less marked than in primary tumors. MG-1 and MG-3 antigens were abolished by neuraminidase digestion and periodate oxidation. MG-5 antigen was likely to be a protein antigen, since it was resistant to neuraminidase digestion and to periodate oxidation but was sensitive to protease digestion.

[A case of hepatoma patient who showed an abnormally high level of serum IRI with the beads method]

A fifty four years old hepatoma patient admitted to the hospital for a surgical operation. Preoperative laboratory examination demonstrated that his serum IRI level was very high (423 microU/ml) when measured with a beads method, however RIA or a microplate method demonstrated normal values. We studied the mechanism of the discrepancy of IRI values. 1) Both the beads and microplate methods demonstrated the same IRI values when the patient's serum insulin was roughly purified with Sep-Pak. The beads method showed high IRI values in serum which passed through Sep-Pak, therefore contained no insulin. 2) The similar results were observed when the patient's serum fractionated by a gel-chromatography (Biogel P-30). The beads method demonstrated high IRI values in both insulin fractions and the fractions containing serum proteins bigger than 40,000 molecular weight. The microplate method demonstrated only one large peak of insulin. 3) When non-specific IgG of guinea pig was used as a fixed antibody instead of human insulin antibody of guinea pig that was used in the beads method, the patient's serum showed the similar values as that obtained with the beads method. We thereby concluded that the abnormal level of IRI by the beads method was derived from the unknown substance reacting with IgG of guinea pig in the patient's serum. After the surgical resection of hepatoma, the levels of IRI measured by the beads method decreased significantly, suggesting that the substance is related to hepatoma cells.

A correlation between arterial ketone body ratio and concentration of beta-hydroxybutyrate as an indicator of hepatic functional reserve

We have investigated the correlation between the arterial blood ketone body ratio (AKBR) and beta-hydroxybutyric acid (HBAC) in the course of a 75 g glucose tolerance test. The correlation was revealed to be represented by an equation of Y = A + BX [X = log(HBAC), Y = log(AKBR)] with high significance. This expression existed in both normal individuals and patients with liver, biliary tract or pancreas disease. The postoperative course was unsatisfactory because of liver dysfunction in cases whose value B was more than -0.6 in bisegmentectomy and more than -0.45 in uni- or subsegmentectomy. The coefficient B in the equation was suggested to contribute to the evaluation of hepatic functional reserve.

Tumorigenicity, invasion, and metastasis of human gastric cancer in nude mice

Tumors derived from 105 patients with gastric cancer were subcutaneously heterotransplanted into nude mice in order to study their tumorigenicity and malignant behavior. Of the 105 gastric cancers, 45 were successfully transplanted (a 42.9% tumorigenesis rate). The tumorigenesis rate of Borrmann type 1 and 2 cancers (77.8%) was significantly higher than that of type 3 and 4 cancers (34.6%). Also, the tumorigenesis rate of differentiated carcinoma (57.1%) was significantly higher than that of undifferentiated carcinoma (30.9%). Spontaneous metastases from the subcutaneous tumors were observed in 5 of the 37 established tumor lines (13.5%), and macroscopic pulmonary metastases were common with one tumor line (SCK-29). Although most of the subcutaneous gastric cancers showed local expansion without distant metastasis, the same tumor cells implanted into the peritoneal cavity exhibited invasive growth and/or metastasis. Thus, the expression of a metastatic phenotype by human gastric cancer was influenced by the host microenvironment. The SCK-29 tumor line with its high metastatic potential may be useful for studies on the mechanism of blood-borne metastasis.

Superficial esophageal carcinoma: a clinicopathological review of 59 cases

During the period from 1975 to 1989, a total of 59 patients with superficial esophageal carcinoma (SEC) were operated on in our Surgical Clinic. Forty patients of the 59 (68%) had been treated during the previous 5 yr. Although 22 patients (37%) complained of slight esophageal symptoms, 12 patients had only symptoms unrelated to esophageal disease, and 25 patients were asymptomatic. In the latter patients, the lesion was found by chance at the time of screening or follow-up examination of upper gastrointestinal tract disease. Endoscopy was very useful for the diagnosis of SEC, and Lugol's solution staining technique was an effective adjunctive means. The lesions in about half of the patients were initially diagnosed by endoscopy in our series. Radiologic diagnosis of the lesions confined to the mucosal epithelium or lamina propria was particularly difficult. Lymph node metastasis was not observed in patients with intraepithelial or mucosal carcinoma. However, the metastasis was demonstrated in 18 of 38 patients (47%) with submucosal invasion. The 5-yr survival rate of patients with SEC was 73%, which was significantly superior to that of patients with advanced esophageal carcinoma (26%). Since the prognosis for the patients with submucosal invasion and lymph node metastasis was poor, we should be enthusiastic about extended lymph node dissection in the surgical treatment for patients in whom submucosal invasion is suspected.

A detailed histological study on occult metastasis of the lymph nodes

One representative microsection from each lymph node was carefully surveyed for metastasis in a routine examination. To scrutinize the existence of occult metastasis, three additional sections were then made from half of the remaining lymph node. A total of 1,698 lymph nodes taken from 55 patients with carcinoma of the esophagus, stomach, colon, thyroid or breast were thus reexamined histologically. The initial examination was not able to prove any metastasis in these lymph nodes. Upon reexamination, however, involvement by cancer cells was detected in 10 nodes of 7 patients. The maximum diameter of the metastatic foci varied from 0.2 mm to 1.3 mm and was less than 0.5 mm in more than half of the nodes. The metastatic patterns in the nodes were classified into three types, i.e., marginal sinus type, medullary sinus type and mixed type. The marginal sinus type was the most frequent, with the mixed type being next and the medullary sinus type being found in only one node. Accordingly, surgeons should keep the possibility of occult metastasis in mind and the marginal sinus of the lymph node should be carefully examined in order to detect any small foci of metastasis.

[A case of local recurrence of rectal cancer successfully treated by UFT combined with two-route CDDP chemotherapy under the AT-II induced hypertension]

A case of local recurrence of rectal cancer was successfully treated by UFT combined with two-route CDDP chemotherapy under the AT-II induced hypertension. UFT (600 mg/day) was orally administered every day. CDDP (75 mg/m2) was infused into the right internal iliac artery via subcutaneously grafted Infuse-a-port under hypertensive state induced by the AT-II (3 micrograms/min). Sodium thiosulfate was intravenously given to protect the CDDP induced nephrotoxicity. The recurrence tumor palpated by digital examination and revealed by MRI disappeared after the fourth two-route CDDP chemotherapy. The serum CEA level elevated before the treatment also normalized. This combined chemotherapy was considered to be an effective measure to cure the local recurrence of rectal cancer.

[Quality of life of patients after esophagectomy for esophageal cancer]

Quality of life of 79 patients who underwent esophagectomy for esophageal cancer and survived more than one year was evaluated by a questionnaire method. About 90% of patients had a good appetite, taking ordinary solid foods, and 69% were satisfied with the daily amount of foods. About 40% of patients complained of passage disturbance on swallowing, abdominal pain or diarrhea after meal. Fifty seven per cent of patients had frequent episodes of cough and sputum, and 20% were not able to go up the stairs to the third floor because of short breath. Thirty two per cent of patients with recurrent nerve paresis and even 5% without paresis had a trouble in daily conversation. These physical distresses were thought to be useful indicators for the doctor to evaluate the quality of life of patients. Additionally, about 30% of patients had a tendency of mental depression postoperatively. Fifty six per cent of patients who had worked before operation returned to work or were doing a lighter work than before. The psychological factor and social rehabilitation were suggested to be very important, when evaluated from the patient's side. Especially in case of aggressive surgery for esophageal cancer, postoperative quality of life of patients should be carefully considered from the viewpoints of both the patient and doctor.

Ambulatory monitoring of indirect beat-to-beat arterial pressure in human fingers by a volume-compensation method

Using a volume-compensation technique, a portable device has been designed for the indirect measurement of beat-to-beat arterial pressure and its waveforms in the basal phalanx of fingers of ambulatory subjects. The device consists of (1) a transmission infra-red photoelectric plethysmograph (TIPP) to detect the variation of arterial volume, (2) a pneumatic cuff with an actuator, (3) a servosystem to control the cuff pressure, and (4) a stereo cassette tape recorder. Arterial pressure was determined from the cuff pressure which was controlled by the servosystem so as to maintain the arterial volume constant at the 'vascular unloading' state. This device is equipped with a compensator for any hydrostatic pressure difference between the heart and finger. Thus, the blood pressure at heart level can be obtained for any finger height. The total weight of the device was 1.6 kg. Blood pressure changes during walking, jogging, jumping, and exercises such as side-stepping, Master's two-step test and car driving, have been successfully recorded.

[Studies on 5-FU concentration and thymidine phosphorylase activity in tissues of patients with colorectal cancer after SF-SP administration]

5-fluorouracil (5-FU) concentrations in peripheral blood, portal blood, normal and cancer tissues were evaluated in 26 patients with colorectal cancer after SF-SP administration (800 mg/day for 10 days). Thymidine phosphorylase activity in cancer tissues was also evaluated. 5-FU concentration in cancer tissues was significantly higher than that in other three specimens, and much higher than 0.05 microgram/g which was reported to be the minimum effective concentration. 5-FU concentration in portal blood was lower than MEC (0.05 microgram/ml). As for the relationship with the pathological features of cancer, the protruding lesions showed a higher 5-FU concentration than the ulcerative ones, and the lesions invaded only to submucosa or proper muscle showed a higher concentration than others. 5-FU concentration ratio in cancer tissues per in peripheral blood (T/B ratio) was related to thymidine phosphorylase activity. The higher was the thymidine phosphorylase activity, the greater T/B ratio. The results suggest that the tumor with higher thymidine phosphorylase activity might have a more pronounced anticancer efficacy of 5-FU.

Expression of the MDR1 gene in human gastric and colorectal carcinomas

We measured expression of the MDR1 gene (also known as the PGY1 gene) in the human gastrointestinal tract. MDR1 messenger RNA (mRNA) levels were elevated in 13 of 15 colorectal carcinoma specimens and in six of 13 gastric carcinoma specimens. Well-differentiated colorectal carcinomas contained significantly higher concentrations of MDR1 mRNA than moderately differentiated colorectal carcinomas. Similarly, moderately differentiated gastric carcinomas contained higher concentrations of MDR1 mRNA than poorly differentiated gastric carcinomas. MDR1 gene expression in normal colorectal and gastric tissues adjacent to carcinomas was similar to that in the carcinomas. MDR1 gene expression in xenografts of colorectal and gastric carcinomas in nude mice was also investigated. Elevated expression of the MDR1 gene was seen in only four of 18 xenografts of colorectal carcinoma and was not seen in any xenografts of gastric carcinoma. P-glycoprotein was distributed over the luminal surface of the colorectal carcinoma. These results imply that the higher levels of MDR1 mRNA found in well-differentiated carcinomas derived from colorectal tissues are the results of increased expression of the MDR1 gene in the luminal surface cells. The level of expression of the MDR1 gene in colorectal and gastric carcinomas appears to correlate with the degree of differentiation and also appears to be affected by transplantation into nude mice.

Serum Lp(a) lipoprotein concentrations of Japanese patients with coronary heart disease

The serum Lp(a) lipoprotein concentration in 103 healthy control subjects was determined by ELISA (TintElise Lp(a) kit, Biopool, Umea, Sweden). The distribution of Lp(a) in the controls was highly skewed (mean 132, S.D. 109, median 99 mg/liter), which is similar to the results previously reported. Serum Lp(a) level in 104 subjects who underwent coronary angiography was also measured. These subjects were divided into two groups: 59 cases of stenosis(-) and 45 of stenosis(+) groups. Lp(a) level of the stenosis(+) group (mean 235, S.D. 197, median 159 mg/liter) was significantly higher than that of the stenosis(-) group (mean 156, S.D. 133, median 123 mg/liter) and of the controls (Wilcoxon test, p less than 0.05 and p less than 0.01, respectively). Further, stenosis(+) group was divided into three subgroups: 20 with single vessel disease, 13 with double vessel disease and 12 with triple vessel disease subgroups. Lp(a) level was correlated with the number of stenotic coronary vessels (Spearman's rank correlation coefficient, p less than 0.05). These results suggest that Lp(a) may play an important part as a risk factor for coronary heart disease.

Serum carcinoembryonic antigen level increases correlate with tumor progression in patients with differentiated gastric carcinoma following noncurative resection

Serum carcinoembryonic antigen (CEA) levels were determined serially in 30 preoperative and postoperative patients with differentiated and 47 with undifferentiated gastric cancers. Macroscopic noncurative resection of the stomach was done for those patients. There was no difference between survival curves in the differentiated and undifferentiated cases, and the 50% survival was 13.1 months for the differentiated group and 12.5 months for the undifferentiated group. Preoperative serum CEA levels were 10.4 +/- 5.2 ng/ml for the differentiated and 4.0 +/- 1.6 ng/ml for the undifferentiated cases, and CEA-positive rates were 20.0% for the differentiated and 14.9% for the undifferentiated cases. There was no difference in preoperative CEA values with regard to tissue types. In the course of tumor progression, CEA levels increased during the first postoperative year in the differentiated cases and related reciprocally to decreases in survival rates. Little change was noted in the undifferentiated cases. Therefore, the serial postoperative assay of serum CEA levels has predictability with regard to tumor progression in patients with a differentiated gastric cancer.

[A case of localized pleural mesothelioma]

A 68-year-old male with localized pleural mesothelioma was described. The tumor was removed surgically in association with left upper pulmonary lobe and regional lymph nodes, since low grade malignancy had been suggested by preoperative needle biopsy. The operative and macroscopic findings revealed that the tumor was well encapsulated and arise from visceral pleura of S3 segment of left upper lobe, projecting into pleural cavity as a pedunculated mass. The tumor measured 9 X 6 X 4 cm in diameter. Based on electron microscopic and immunohistochemical findings of the tumor, the origin of tumor cells was discussed.

Electric impedance cuff for the indirect measurement of blood pressure and volume elastic modulus in human limb and finger arteries

A new plethysmograph, the electric impedance cuff, was designed for the indirect measurement of blood pressure, volume elastic modulus Ev and compliance Ca in human limb arteries. This comprises a compression chamber filled with electrolyte solution and a tetrapolar electric impedance plethysmograph whose electrodes are placed inside the chamber; the former for controlling transmural arterial pressure Pt, and the latter for detecting total limb volume Vo, mean arterial volume Va and its variation delta Va. Systolic and mean arterial pressure in the upper arms, forearms and fingers were measured by detecting pulsatile impedance variation during the gradual (3-5 mm Hg per heart beat) increase (or decrease) in chamber pressure by the volume oscillometric technique. Diastolic and pulse pressure delta P were calculated from these pressure values. Compliance Ca = delta V/delta P and volume elastic modulus Ev = delta P/(delta Va/Va) were recorded at various Pt levels, controlled by the compression pressure. Although this is a kind of impedance plethysmograph, the volume change in a limb segment can be detected by this method without passing electric current through the limb.

[Intraperitoneal chemotherapy in gastric cancer with peritoneal metastasis using totally implantable peritoneal access system]

Fifteen patients with peritoneal metastasis of gastric cancer were treated with mainly ip-ETP (Etoposide: i.p., THP-ADM: i.v. and CDDP: i.p.) or other drugs by the use of a totally implantable peritoneal access system. In principle, intraperitoneal drug delivery was carried out every two weeks. CDDP was administered into the intraperitoneal cavity with intravenous sodium thiosulfate delivered simultaneously to protect against cisplatin-induced nephrotoxicity. RI-scintigram showed that the intraperitoneal catheter was fully useful even six months after the operation. As a result, performance status has been improved in 12 out of 15 cases, and ascites disappeared in 3 out of 6 cases with same. Ten cases have been alive for more than 6 months after operation. There have been no severe complications (e.g., nephrotoxicity or myelosuppression) even in the cases treated at frequent intervals for more than 8 months. The findings in this study indicated that ip-ETP using totally implantable peritoneal access system is beneficial for advanced gastric cancer with peritoneal metastasis.

[Two-route chemotherapy under AT-II induced hypertension using totally implanted injection port system in liver metastases derived from digestive cancers]

Two-route chemotherapy (TRC) with intraarterial infusion of cis-diamminedichloroplatinum and intravenous infusion of sodium thiosulfate was carried out on 8 cases of digestive cancer with liver metastases, using totally implanted injection port system. The metastases occurred from gastric cancer in 3 cases and from colonic cancer in 5 cases. Computed tomography and/or ultra-sonography revealed an overall response rate of 50% (4/8). Complete response (CR) was obtained in two cases. The therapy was repeated 12 times in one case of gastric cancer with multiple liver metastases and 5 times in another rectal cancer with a solid metastatic tumor. In the latter case, a right hepatic lobectomy was performed thereafter. The histology of the hepatic tumor showed mucin lakes and necrotic lesions, and no viable cancer cells were observed. This mode of chemotherapy was therefore considered a useful measure for the treatment of liver metastases derived from digestive cancers. Furthermore, no serious side effects occurred.

[A resected case of triple cancer in the uterus, lung and thyroid]

A 62 year-old woman was admitted to our clinic for the treatment of lung cancer. Right middle and lower lobectomy was performed. Histological diagnosis was well differentiated adenocarcinoma in the right lower lobe (yp-T2N1M0, stage II). Forty-seven months before the pulmonary resection (at the age of 57 year-old), she had undergone hysterectomy for squamous cell carcinoma of the uterus (carcinoma in situ). Forty-three months after the pulmonary resection (at the age of 65 year-old), two minute thyroid cancer were resected. Twenty-one resected cases of triple cancer including lung cancer have been reported in Japanese literature.

Difference in main lymphatic pathways from the lower esophagus and gastric cardia

Lymphatic pathways draining the lower esophago-cardiac region were studied in 17 patients with carcinoma of the lower esophagus or gastric cardia, by measuring radioisotope uptakes in the regional lymph nodes. The uptakes were most remarkable in lower mediastinal and upper gastric lymph nodes, when the radioactive colloid was injected at the lower esophagus. A lesser degree of uptakes were observed both in other mediastinal and abdominal lymph nodes. On the contrary, a high degree of uptakes were detected only in abdominal lymph nodes, when the colloid was injected at the gastric cardia. The results indicated that main lymphatic pathways originating from the lower esophagus advance both upward and downward, and that those from the gastric cardia make their way downward to upper gastric, para-celiac and para-aortic lymph nodes. The actual incidences of lymph node metastases were also studied in 108 patients with carcinoma of the lower esophagus and 93 patients with carcinoma of the gastric cardia. In the former group, very high incidences were observed in lower esophageal and upper gastric lymph nodes. In the latter group, the incidence was most remarkable in upper gastric lymph nodes and far less significant in lower mediastinal lymph nodes. The results confirmed those of the radioisotope study. The importance of dissection of para-aortic lymph nodes near the left renal vein was also stressed.

[Lymph node metastases in the thoraco-cervical transitional region in thoracic esophageal cancer--with ultrasonic detection and a comment on the guide lines]

Lymph node metastases in the thoraco-cervical transitional region (TCTR) and its ultrasonic detection were evaluated in 64 patients with thoracic esophageal cancer, who received radical esophagectomy with modified neck dissection. Lymph node metastases in TCTR were found in 19 of 64 cases (29.7%). Nodal metastases in the supraclavicular region were found in similar incidence of 23.4% (15 of 64 cases). Lymph nodes in both regions were infiltrated in 8 cases. Direct metastases to supraclavicular region and metastases in single region of TCTR were indicated in 4 cases equally. The degree of lymph node metastases of 11 patients suffered from middle intra-thoracic esophageal (Im) cancer with nodal involvement in TCTR were divided into three groups, two cases of n2, one of n3 and eight of n4, according to the Guide Lines. Convex type probe excelled in description of TCTR. Swollen lymph nodes were detected in 12 out of 19 cases with metastases by preoperative ultrasound using this probe (sensitivity of 63.2%). Forty-four of 45 cases without metastases were diagnosed as such (specificity of 97.8%). The partition of TCTR in the Guide Lines should be reconsidered for better evaluation of the results on lymph node metastases in this region.

Vibration technique for indirect measurement of diastolic arterial pressure in human fingers

Diastolic pressure Pd was indirectly measured by vibrating a finger artery with a 10 Hz sinusoidal pressure variation during a gradual increase (or decrease) in occlusive cuff pressure Pc. Pulsatile arterial volume changes on which sinusoidal variations are superimposed were detected by a transmitted infra-red photoelectric plethysmograph (TIPP). It is known that volume change in an artery shows a maximum amplitude at the transmural pressure Pt level equal to 0 mm Hg due to the nonlinear viscoelastic properties of the arterial wall. For the same reason, the amplitude of the sinusoidal volume variation reached its maximum at the end-diastolic phase, when Pc was controlled to be exactly equal to Pd. The indirect Pd values determined from Pc were compared with those simultaneously measured by a direct method in rabbit forelegs and by the volume-compensation method in human fingers. Using the principle of the volume oscillometric method systolic and mean pressures were also determined by this system.

Acute cytogenetic effects of potassium bromate on rat bone marrow cells in vivo

The acute cytogenetic effects of potassium bromate (KBrO3) on rat bone marrow cells in vivo were studied. The incidence of chromosome aberrations in bone marrow cells increased rapidly, reaching a maximum level 12 h after intraperitoneal injection and decreased within 24 h. Dose-response relationships were obtained for both intraperitoneal and oral administrations.

[Clinicopathological studies of the recurrence of esophageal squamous cell cancer--with special reference to the mode of recurrence and operative procedure]

In 93 out of 201 patients (46%) with squamous cell carcinoma of the esophagus who underwent radical resection (excluding death within 30 days after operation), the site of recurrence could be identified by means of X-ray, CT, ultrasonography, and biopsy. Recurrence was found in 55% of 93 cases within 12 months after surgery and in 86% of 93 cases within 24 months. Of 93 patients with recurrences, lymph node recurrences were present in 44 cases, visceral recurrences in 32 cases, both lymph node and visceral recurrences in 11 cases and others in 6 cases. Neck and/or upper mediastinal lymph node recurrences were found in 10 out of 15 patients who had recurrences within 3 months after surgery. Careful examination should be made in the left recurrent nerve chain and extended lymph node resection of upper mediastinal region should be performed under the adequate indication. Esophageal squamous cell cancer has a tendency to recur in the lymph nodes initially, and visceral metastases may occur thereafter. The incidence of visceral recurrence increased remarkably, when neck and/or upper mediastinal lymph nodes were involved at the time of operation. Accordingly, both irradiation and chemotherapy should also be applied for improving the prognosis of esophageal carcinoma.

[The significance and the indication to dissect para-aortic lymph nodes in esophageal and cardiac cancers]

Recently, now that the para-aortic lymph nodes have become a focus of attention, there has been a tendency to dissect the para-aortic lymph nodes of the abdomen for cases of esophago-cardiac cancers. One of the reasons why R4 procedures are being performed is due to the development of a clear analysis of the lymphatic pathways. In view of the importance of para-aortic lymph nodes, particularly focusing on the lymph nodes adjacent to left renal vein, we also are performing extended systemic lymph node dissections in certain cases. In determining the indication, a preoperative diagnosis by echogram of the neck region is important, and also a diagnosis of the para-aortic region as well. The significant benefit of para-aortic dissection is to be able to carry out a complete R3 procedure.

Computerized morphometry of liver cells in diffuse hepatic diseases

Computerized morphometrical measurements were made of liver cells and their nuclei taken from livers of healthy persons and from patients with acute hepatitis (AH), chronic hepatitis (CH), and liver cirrhosis (LC). Liver biopsies were performed on 127 people (24 convalescing from acute hepatitis, 20 with chronic inactive hepatitis (CIH), 24 with chronic active hepatitis (CAH), 38 with liver cirrhosis (LC) and 21 who were healthy controls (HC]. The specimens were stained with hematoxylin-eosin, then light microscopic pictures were obtained. The original cells were magnified 1000 times. The sizes of the cells and of their nuclei were calculated using a computer. Correlative variation was noted in cell and nuclear sizes resulting in an consistently constant nucleus-cytoplasm ratio. Average sizes of both cells and nuclei were maximal in livers with LC, followed in decreasing order by those in livers with CAH, CIH, HC and convalescent AH. The smallest cells and nuclei were found in convalescent AH cases. It might be possible to some degree to obtain gross impressions of the histopathological type of the liver lesion by measuring the sizes of cells and nuclei of the liver.

[Antitumor effect of intermittent oral administration of UFT against human rectal cancer xenografted in nude mice]

Effect and toxicities of oral administration of UFT were examined with tumor xenografts (COK-7LiM) in nude mice. Special attention was paid to the differences between daily (Q1D X 9) and intermittent (Q4D X 3) treatments with this agent. The optimal doses of UFT were determined on the basis of the maximal tolerated dose of the agent in nude mice. It was remarkable that the chemotherapeutic effect by intermittent administration of UFT showed a significantly better result than that by daily administration. No difference was seen in the toxicities between the two methods of administration of UFT. Moreover, the concentration of 5-FU in the tumor tissue treated with UFT intermittently was significantly higher than that by daily administration method.

Antrum preserving double tract method for reconstruction following proximal gastrectomy

The antrum preserving double tract method was originally designed in order to gain the smooth transfer of larger foods through the duodenal route. Surgical improvement was then made at a few points when carrying out the anastomosis between the residual stomach and the jejunum. In the clinical field, this method is characterized by a better transfer of large foods into the duodenum than the conventional double tract method. The clinical investigation revealed that gastrin release remained after the operation due to both the good passage and the presence of food in the residual stomach. The antrum preserving double tract method is a reasonable and simple method which can maintain physiological pancreaticocibal synchronism.

Excitatory input to burst neurons from the labyrinth and its mediating pathway in the cat: location and functional characteristics of burster-driving neurons

1. Spikes of single neurons were recorded extracellularly in the cat prepositus hypoglossi nucleus and the underlying reticular formation and were identified as type II neurons by horizontal rotation. Among these neurons, those activated by contralateral vestibular nerve stimulation with short latencies (1.5-3.0 ms) were selected for further study. 2. A class of these identified neurons was antidromically activated from the contralateral excitatory burst neuron (EBN) area immediately rostral to the abducens nucleus. Systematic tracking for antidromic stimulation revealed a wide distribution of effective spots in and near the EBN area, with varied latencies and thresholds, suggesting terminal branching in that area. The same neurons were also antidromically activated from the contralateral inhibitory burst neuron (IBN) area, the region near the midline, and the nucleus reticularis tegmenti pontis. 3. These neurons exhibited a characteristic firing pattern related to nystagmus: with contralateral rotation the firing rate gradually increased during the slow phase (type II response) and further steeply increased in a burst fashion before and during the contraversive quick phase. Since the time of occurrence of burst activity in these neurons was similar to that of contralateral ENBs and IBNs that received their axonal projection, it is suggested that they send excitatory input to burst neurons, and can thus be called burster-driving neurons (BDNs). 4. Intracellular study revealed that stimulation of the BDN area produced monosynaptic EPSPs in contralateral EBNs. The monosynaptic connection of BDNs with EBNs was confirmed by detecting unitary extracellular synaptic currents of EBNs with the spike-triggered averaging technique. 5. In contrast to BDNs, another class of nystagmus-related type II neurons in the prepositus hypoglossi and medullary reticular formation showed a discharge pattern similar to that of abducens motoneurons on the same side. None of them was antidromically activated from the contralateral pontine reticular formation including the EBN area. Some neurons responded antidromically to stimulation of the ipsilateral dorsomedial pontine reticular formation. 6. In conclusion, the input from the horizontal canal during rotation reaches the contralateral prepositus hypoglossi nucleus and the underlying reticular formation through the vestibular nuclei, and a class of neurons in these structures (BDNs) responds to the canal input in a burst fashion following a tonic type II activity. The axons of BDNs cross the midline and monosynaptically excite EBNs on the side of the canal stimulated.(ABSTRACT TRUNCATED AT 250 WORDS)

Effective chemotherapy for small cell carcinoma of the esophagus

This article documents the use of chemotherapy in a case of small cell carcinoma of the esophagus with multiple liver and lymph node metastases. A multi-drug regimen was used and included cis-dichlorodiamine platinum (CDDP), VP-16, vincristine (VCR), adriamycin (ADM), and cyclophosphamide (CPA). After chemotherapy, the esophageal tumor disappeared, and liver masses reduced in number and degenerated. Nine months later, however, the patient died of brain metastases. It was concluded that radiotherapy should be given to the brain for the prophylaxis of tumor relapse.

Effective chemotherapy for small cell carcinoma of the esophagus

This article documents the use of chemotherapy in a case of small cell carcinoma of the esophagus with multiple liver and lymph node metastases. A multi-drug regimen was used and included cis-dichlorodiamine platinum (CDDP), VP-16, vincristine (VCR), adriamycin (ADM), and cyclophosphamide (CPA). After chemotherapy, the esophageal tumor disappeared, and liver masses reduced in number and degenerated. Nine months later, however, the patient died of brain metastases. It was concluded that radiotherapy should be given to the brain for the prophylaxis of tumor relapse.

Lymph drainage originating from the lower esophagus and gastric cardia as measured by radioisotope uptake in the regional lymph nodes following lymphoscintigraphy

Lymph drainage originating from the lower esophagus and gastric cardia was determined using uptake of radioisotope (RI) in the regional lymph nodes in 19 patients with primary cancer at these sites. On the day prior to operation, 99m Tc colloid solution was injected submucosally in the distal esophagus or gastric cardia during endoscopy. The regional lymph nodes were removed at operation and RI uptake of individual nodes was measured in a well-type scintillation counter. Uptake was expressed as the amount per nodal weight. After radioactive colloid was injected into the lower esophagus, high RI uptake was common in both the mid-mediastinal and abdominal nodes, suggesting that lymph originating from the lower esophagus drains in both a superior and inferior direction. On the other hand, after radioactive colloid was injected into the gastric cardia, high RI uptake was never demonstrated in mediastinal lymph nodes suggesting that direct mediastinal lymph flow from the gastric cardia is rare. These results support clinical observations on the distribution of lymph nodal metastases in patients with lower esophageal and gastric cardia malignancies. As a diagnostic tool for lymph nodal metastases, however, lymphoscintigraphy is unreliable.