[A case of secondary leukemia induced by chemotherapy with a CDDP-based regimen for gastric cancer 5 years following radical resection]

Cisplatin, mitomycin C and 5-fluorouracil were given a 55-year-old woman for an unresectable gastric cancer, and successful radical gastrectomy was performed. Postoperative adjuvant immunochemotherapy using UFT and PSK was continued for about 4 years and 4 months. Pancytopenia was observed at 5 years after the treatment and then marked leucocytosis was noted. She also showed complications of general fatigue, appetite loss etc. A secondary acute leukemia associated with eosinophilia was diagnosed by peripheral blood examinations, showing WBC, 122,400: blast, 37.5 % and eosinophil, 41%. Results also showed atypia and pseudo-Pelger nuclear abnormality of eosinophil, high positive stain of cell myelogenic cell surface marker, many numeral and structural abnormalities of chromosomal analysis, etc. From the above results, it was suggested that the leukemia might be induced by previously performed chemotherapy. The patient died about 2 months following its onset.

C-fos expression in the rat brain after intraperitoneal injection of lithium chloride

The distribution of evoked expression of the proto-oncogene c-fos was immunohistochemically examined in the rat brain after intraperitoneal injection of isotonic LiCl, which is commonly used to induce internal malaise in the conditioned taste aversion paradigm. C-fos-like immunoreactive neurones (c-fos neurones) were most densely observed in the central amygdaloid nucleus, external lateral subnucleus of the parabrachial nucleus (PBN), posteromedial and commissural parts of the nucleus of the tractus solitarius (NTS) and area postrema (AP). Experiments including vagotomy, intravenous injection of LiCl and lesions of the area postrema suggest that NTS neurones are activated via both sides of the vagus nerves, while AP neurones, humorally as well as neurally via the vagal nerve with a right side predominance. The activated NTS and AP neurones project mainly to the external lateral subnucleus of the PBN and lightly to the central lateral subnucleus of the PBN. These results are discussed in terms of the role of LiCl in the formation of conditioned taste aversion.

Effect of a partial deletion of Y chromosome on in vitro fertilizing ability of mouse spermatozoa

The effect of a partial deletion of Y chromosome on sperm fertilizing ability was investigated through an in vitro fertilization technique. Epididymal spermatozoa of a congenic line, B10.BR-Ydel, which is characterized by a high incidence of abnormal spermatozoa, revealed a significantly lower in vitro fertilization rate (22%) than that (79%) of its control strain (B10.BR/SgSn), which has a normal-sized Y chromosome. Incidence of capacitated spermatozoa as determined by chlortetracycline fluorescence assay was significantly lower in B10.BR-Ydel than in B10.BR/SgSn spermatozoa. The fertilization rate was significantly improved when B10.BR-Ydel spermatozoa were separated from the supernatant of sperm suspension by Percoll gradient centrifugation. A reconstitution experiment revealed that the B10.BR-Ydel spermatozoa were more sensitive to the inhibitory effect of the supernatant than B10.BR/SgSn spermatozoa. Spermatozoa from F1 (C57BL/6N male x B10.BR-Ydel female) males showed higher fertilization rates than those from F1 (B10.BR.Ydel male x C57BL/6N female) males. These observations suggest that not only the morphology but also the fertilizing ability of spermatozoa is directly related to partial deletion of Y chromosome.

[Clinical studies on locoregional immunochemotherapy of peritonitis carcinomatosa]

Although 58 patients with peritonitis carcinomatosa underwent multidisciplinary therapy over the last 5 years in our department, about half of them died within 3 months after treatment. In addition, the prognosis was poor for gastric and colon cancer patients, who had macroscopic peritoneal dissemination. Therefore intraoperative intraperitoneal administration of either BRM or anticancer drugs was performed for the microscopic peritoneal dissemination of the cancer, and the immunological response in the peritoneal cavity was examined. In terms of subpopulation of peritoneal exudate cells, neutrophil leucocytes were predominant and thereafter lymphocytes increased. As for the cytokines in the exudate from peritoneal cavity, the concentration of interleukin-6 peaked within 24 hours after administration, followed by a gradual decrease, while the concentration of interferon-gamma was detectable at more than 24 hours after operation, followed by a gradual increase. Tumor necrosis factor-alpha was also detectable in the exudate. Its concentration decreased when both OK-432 and MMC were administered, but it increased when CDDP was administered. The above results indicated that preventive intraoperative intraperitoneal administration of BRM and anticancer drugs should bring about individual immunokinetic modulation in tumor bearing host and both cytokines and immunocytes could play an important role in locoregional tumor immunity.

[Significance of antitumor effects and immunological response on endogenously induced LAK therapy for primary or metastatic liver tumor]

Nineteen patients with metastatic liver tumor (9 of gastric cancer, 5 of colon cancer, 2 of pancreatic cancer, one each of mammary cancer, cholecystic cancer, carcinoid of biliary tract) and one patient with primary liver cancer were treated by endogenously induced LAK therapy consisting of transhepatic arterial infusion with ADM or MMC for induction therapy and OK-432 and rIL-2 (TGP-3) for immunotherapy. The following results were obtained. 1) Clinical response for liver tumor showed no CR but 8 cases of PR, for an overall response rate of 42.1%. 2) Reduced tumor marker value was noted in 76.5% cases, and 50% survival term became 349 days after the therapy. 3) Many CD4 and CD8 positive mononuclear cells had infiltrated around liver tumor after therapy by immuno-histochemical staining of surface marker. 4) NK activity of peripheral blood lymphocytes was markedly reduced soon after the therapy and continued for about 4-7 days, while in cases of combined subcutaneous administration with OK-432, NK activity showed only a slight decrease.

Acquisition of a sucrose utilization system in Escherichia coli K-12 derivatives and its application to industry

An Escherichia coli strain, B-62, that was isolated from a clinical source and was epidemiologically unrelated to E. coli K-12 was the source of chromosomal DNA for a sucrose utilization system (Scr+) in the construction of a plasmid, pST621. The cloned insert of a gene encoding Scr+ in pST621 conferred a sucrose-positive phenotype onto transformed cells of E. coli K-12 derivatives. Sucrase activity of the transformants was as high as that which would correspond to a "gene dosage effect" of a vector plasmid pBR322, whereas the transformants' sucrose uptake activity was always lower than that of E. coli B-62. A region within an XhoI-SacI fragment (3.2 kb) of pBR322-glyA was replaced in the construction of another plasmid, pST5R7, by a fragment (about 2.6 kb) of pST622 containing the gene encoding Scr+. A genetically stable Scr+ derivative of E. coli K-12 was obtained by introducing the gene encoding Scr+ onto E. coli chromosome via homologous recombination between pST5R7 and the chromosome and subsequent plasmid segregation. The use of low-copy-number plasmid RP4 as a cloning vector was also effective for enhancing the stability of Scr+. Tryptophan producers E. coli SGIII1032S, in which the gene encoding Scr+ was cloned onto the chromosome, and E. coli SGIII1032, which carried Scr+ plasmid RP4.5R7, produced from 6% sucrose in shake flasks (33 degrees C, 96 h) 2.3 and 5.7 g of tryptophan per liter, respectively.

Tetraparental mice reveal complex cellular interactions of the mutant, autoimmunity-inducing lpr gene

Lpr is a murine recessive autosomal mutant gene that, in conjunction with the background genes of different inbred mouse strains, produces varied syndromes of lymphadenopathy and autoantibody production. We have investigated the cellular basis of the lpr determined phenomena by constructing allophenic (tetraparental) chimeras of MRL/Mp-lpr/lpr combined with C57BL/6 and MRL/+ combined with C57BL/6-lpr/lpr. The appearance of lymphadenopathy, lpr atypical T cells, and autoantibodies was found to depend on the relative amounts +/+ and lpr tissue. The failure of these three abnormalities to correlate in certain animals suggested different pathways of lpr gene action. Furthermore, in the lpr predominant animals, both the lymphadenopathy and autoantibodies were essentially entirely contributed by the lpr donor. The expression of the lpr gene within the same cells expressing the MRL or B6 background determined the pathologic and serologic manifestations characteristic of the disease of that lpr strain, despite the presence of +/+ cells of the other background in the same individual. The lpr syndrome thus depends on the intracellular interaction of the lpr and background genes, and on positive signalling between different lpr cell populations.

Tetraparental mice reveal complex cellular interactions of the mutant, autoimmunity-inducing lpr gene

Lpr is a murine recessive autosomal mutant gene that, in conjunction with the background genes of different inbred mouse strains, produces varied syndromes of lymphadenopathy and autoantibody production. We have investigated the cellular basis of the lpr determined phenomena by constructing allophenic (tetraparental) chimeras of MRL/Mp-lpr/lpr combined with C57BL/6 and MRL/+ combined with C57BL/6-lpr/lpr. The appearance of lymphadenopathy, lpr atypical T cells, and autoantibodies was found to depend on the relative amounts +/+ and lpr tissue. The failure of these three abnormalities to correlate in certain animals suggested different pathways of lpr gene action. Furthermore, in the lpr predominant animals, both the lymphadenopathy and autoantibodies were essentially entirely contributed by the lpr donor. The expression of the lpr gene within the same cells expressing the MRL or B6 background determined the pathologic and serologic manifestations characteristic of the disease of that lpr strain, despite the presence of +/+ cells of the other background in the same individual. The lpr syndrome thus depends on the intracellular interaction of the lpr and background genes, and on positive signalling between different lpr cell populations.

[The muscular arch of the axilla and its nerve supply in Japanese adults]

We examined 94 axillary regions of 47 Japanese adults and found the muscular arch of the axilla (Maa) in five sides of three cadavers as well as the tendinous arch of the axilla (Taa) in two sides of two cadavers. The results are summarized as follows: 1) The frequency of Maa was 6.4% of the total bodies and 5.3% of the sides in this series. 2) In the left side of a 57-year-old male (No. 427), Maa was attached to the surface of the coracobrachialis muscle after fusing with the dorsal surface of the inserting tendon of the pectoralis quartus muscle. Both muscles were supplied by the caudal pectoral nerve (Npc) from the medial pectoral nerve. Moreover, in this same specimen, the sternalis muscle was recognized on the ventral surface of the pectoralis major muscle. In the left side of a 93-year-old female (No. 386), the cranial part of the muscular arch of the axilla (Cpa) was extended to the coracoid process by a tendon and attached to the abdominal part of the pectoralis major by two muscle bundles supplied by independent branches from Npc. One muscle bundle was attached to the lower margin of the abdominal part of the pectoralis major on the same plane, and the other bundle was located on the dorsal surface of the abdominal part. In a 74-year-old female (No. 411), the well-developed lateral part of the muscular arch of the axilla (Lpa) was attached to the inferior side of the tendinous arch. According to Ruge (1914) and Kasai et al. (1977), this arch was in the transition of the muscle bundle of Cpa to the arch. In the right side of the same specimen, only the thoracodorsal nerve (Ntd) was distributed into Lpa, whereas in the left side, only Npc supplied branches to Lpa. 3) The axillary arch was classified into 8 types based on the form and the supplying nerve of Cpa and Lpa. Cpa consisting of the muscle bundle is Type I, and Cpa consisting of the tendinous arch is Type II. We proposed that only Type II-A, with Cpa as tendinous arch and no Lpa, be designated as Taa (found in two cases), and the others as Maa. The following types were found in this study: Type I-A, consisting of only Cpa supplied by Npc (two cases); Type I-D, consisting of Cpa supplied by Npc and Lpa supplied by Ntd (one case); Type II-B, consisting of the tendinous arch and Lpa supplied by Npc (one case); Type II-D, consisting of the tendinous arch and Lpa supplied by Ntd (one case). 4) From the above findings, it can be suggested that Maa of varying shapes have been formed by a portion of the latissimus dorsi muscle supplied by Ntd, together with the pectoralis subcutaneous muscle, consisting of the pectoralis abdominalis, humeroabdominalis, humerodorsalis and ventrolateralis muscles supplied by Npc. The latter three muscles were proposed by Ura (1937) as the panniculus carnosus muscle, which was well developed in some lower mammalian orders. However, early investigators suggested that Maa was derived from the panniculus. Maa might have occurred as a rudimentary phylogenetic remainder in an early human embryonic stage.

[Therapeutic effect of transarterial infusion immunochemotherapy for metastatic liver cancer]

In order to improve therapeutic efficacy for metastatic liver cancer, intermittent transarterial administration of BRM in combination with anticancer drugs was performed by use of reservoir apparatus. A total of 22 patients (12 cases of gastric cancer, 6 of colon cancer, 2 of pancreas cancer, 1 of gall bladder cancer and 1 of biliary tract carcinoid) were treated according to the following schedule: both 10 mg of ADM (or MMC) and 0.5 KE (or 1.0 KE) of OK-432 were administered on day 1 and 40 x 10(4) JRU of recombinant interleukin 2 (r-IL 2) on day 4, 7 and 11. The treatment was repeated as many times as possible. In terms of direct antitumor effect and decrease of tumor marker, the response rate was 43% (6 cases out of 14) and 75% (9 cases out of 12), respectively. As for performance status, improvement, no change and deterioration were seen in 4 cases, 8 cases and 3 cases, respectively. Even though 13 patients died, 8 of them survived more than 300 days. In the case of gastric cancer patients with liver metastasis, 50% survival time of 12 cases was 334 days, while that of 30 cases, who were administered anticancer drugs only systemically, was 144 days. In 3 cases the decrease in the size of tumors located in both liver and the other metastases also was seen. Every case developed high grade fever, but an antifebrile was effective. Otherwise severe side effects were not seen. These results indicated that intermittent arterial infusion immunochemotherapy was feasible for the treatment of metastatic liver cancer.

[A long-term survival case of advanced gastric cancer undergoing radical gastrectomy by second-look operation after successful chemotherapy (CDDP, MMC, 5-FU)]

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor characterized by S3 (invasion of the pancreas), N3, P0 and H0. She was then treated by combined administration of cisplatinum, mitomycin C and 5-fluorouracil. A remarkable response (CR) was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation about 8 weeks after chemotherapy, a successful radical total gastrectomy with R2 (partially R3) lymphnode dissection was performed. Histological examination of the specimens, including the stomach and lymphnodes, revealed no cancer cells in any region (pCR). She had been given UFT and PSK for 4 years 4 months after reoperation. She has lived for 5 years 2 months after reoperation without any signs of recurrence or metastases.

Development of liver metastasis in colorectal carcinoma. With special reference to venous invasion and basement membrane laminin

The development of hepatic metastases in 344 patients with colorectal carcinoma was examined for correlation with the presence of both venous invasion by the primary tumor and basement membranes in the tumor tissue. The former was detected by Victoria blue and hematoxylin-eosin staining and the latter by antilaminin antibody. A significant difference in the incidence of venous invasion was noted between patients with and those without liver metastasis at surgery. Basement membrane deposition was found in half of all cases of well differentiated adenocarcinoma, which was significantly high compared with other tumor types. This was more distinct in metastatic foci in the liver and lymph nodes than in the primary lesion, but less marked in intravascular tumor tissue. Basement membrane deposition was seen more frequently in Dukes' A tumors than in B tumors, although this was not statistically significant. No relationship was found between basement membrane laminin positivity and five-year survival, nor was there any correlation between the incidence of liver metastasis and tumor histologic type. Venous invasion was considered to be intimately related to the development of liver metastasis. Deposition of laminin-positive basement membrane was dependent on the grade of tumor differentiation, whereas it had no direct relation to the development of liver metastasis.

[Relationship between the prognosis and nuclear DNA histograms in gastric cancer patients with a synchronous liver metastases who were given a combined gastrectomy and hepatectomy]

Out of 127 gastric cancer cases with a synchronous liver metastases, the relationship between the prognosis and the nuclear DNA contents in the primary and liver metastatic foci has been investigated in 10 relatively noncurative patients who had received a combined gastrectomy and hepatectomy. In 3 out of 5 long-term survival cases, low ploidy patterns were seen in both foci, whereas in 1 out of 5 short-term survival cases, a multiplicity was observed, i.e., a low ploidy in the primary focus and a high ploidy in the liver. In the other 4 short-term survival cases, high ploidy patterns were noted in both foci.

A case of primary mucinous cystadenocarcinoma of the appendix with elevated serum carcinoembryonic antigen (CEA)

We report a 69-year-old female patient with mucinous cystadenocarcinoma of the appendix and elevated serum carcinoembryonic antigen (CEA). Serum CEA levels were 27.6-37.8 ng/ml. An oval shaped cystic mass at the ileocecal region was consistently seen by several radiologic procedures such as, barium enema, ultrasonography, computed tomography, and magnetic resonance imaging. The tumor was resected, and the histopathologic findings indicated mucinous cystadenocarcinoma of the appendix. CEA was demonstrated in the neoplastic columnar cells in immunohistochemical studies. The literature on the determination of serum CEA level in adenocarcinoma of the appendix is reviewed.

[Intraoperative intraperitoneal administration of mitomycin C and OK-432 for peritoneal dissemination of gastric cancer]

In order to improve the prognosis, intraoperative intraperitoneal administration of both mitomycin C and OK-432 was performed for the peritoneal dissemination of gastric cancer. Some 74 of 469 patients of gastric cancer, who underwent surgical treatment over the last 7 years in our department, had peritoneal dissemination and 24 of them were treated with the drugs described above. However, there was no significant difference between treated group and controlled untreated group. No severe side effects were noted except for moderate pyrexia. It is still too early to determine the effect of this treatment because of both the short duration of follow-up and the small number of analyzed cases. In the future, we are planning to apply this treatment to selected cases, for which a histological diagnosis will be made intraoperatively by use of irrigation cytology and/or stamp biopsy.

[A case of metastatic malignant melanoma of the stomach treated by a surgical operation]

A metastatic malignant melanoma of the stomach is not a disease of rate occurrence, but reports of melanomas that were clinically diagnosed and were treated by a surgical operation are rare. The case presented is a 73-year-old woman, who underwent an excision of a malignant melanoma of the left sole in 1981. Subsequently, she had a subcutaneous metastasis of a melanoma three times and was treated by a resection and immunochemotherapy. In January, 1988, an X-ray examination of stomach revealed a giant elevated lesion, and an endoscopic examination of the stomach revealed a black pigmented tumor with ulceration. A biopsy taken from the tumor confirmed the diagnosis of a malignant melanoma. Thus, she was given a total gastrectomy. Reports in the Japanese literature of metastatic malignant melanomas of the stomach diagnosed while the patient was still living amount to 11 cases. Of this number, 3 patients were given a surgical operation. Further, these 3 patients lived longer than the non-surgically treated cases and had a better quality of remaining life.

[Examination of the rectosphincteric reflex by means of endoscopic electrical stimulation. A new device]

An endoscopic electrical stimulation method (the new method) for the examination of the rectosphincteric reflex was devised to overcome difficulties attributable to the manometric method using balloon stimulation. Safety of the electrical stimulation under the conditions used routinely, was confirmed symptomatically and histologically. It was found that the optimal parameters of electrical stimulation to obtain the recto-sphincteric reflex were: 1 ms, 20 Hz, 5 to 7mA, and for 3 sec. The degree of the reflex relaxation became less and the time lag of the response to the stimulation became longer, as the distance of the stimulation site from the anal verge was increased. These relationships were significant. In the cases which received anterior resection of the rectum, the rectosphincteric reflex was examined using the new method. In 12 of 39 cases the recto-sphincteric reflex was induced by stimulation at the oral side of the anastomosis. In all of them the reflex was observed at 9 or more months postoperatively. Incidence of postoperative reflex appearance tended to be higher after end-to-end anastomosis than after side-to-end anastomosis. In two cases which received Duhamel-Okamoto's operation and in one which received Soave-Denda's operation, it was possible to analyze the relationship between the stimulating site and presence or absence of the reflex-like phenomenon.

[A case of ruptured middle cerebral artery aneurysm with acute subdural hematoma after clipping of the aneurysm nine years previously]

It is known well that acute subdural hematoma develops most frequently after head injury, and secondly from pathological lesions such as intracranial ruptured aneurysm or AVM. A case of ruptured middle cerebral artery aneurysm which was clipped nine years before resulting in acute subdural hematoma is reported. At 6 pm on July 21, 1988, a 53-year-old woman with severe headache starting at 4:20 pm was transferred to our hospital. She suffered from herniated signs; Conscious disturbance; anisocoria; positive OCR; decerebrate posture. An emergency CT showed right acute subdural hematoma with severe midline shift. Following a decompressing craniotomy at 9 pm, the subdural clot was evacuated. It measured 90g in volume and the underlying cortex was normal. There was no evidence of SAH. Right carotid angiography three weeks after the first operation showed a middle cerebral artery aneurysm at the site of a clip which had been applied nine years ago. A second operation was performed on August 30, 1988. Via the right pterional route, the middle cerebral artery aneurysm was clipped successfully with a Sugita's clip replacing the first clip. We concluded that the regrowth and rebleeding of the middle cerebral artery aneurysm which had been clipped nine years before was most probable. She was discharged with slightly decreased consciousness and right motor weakness, on November 13, 1988.

[Treatment of the association of arteriovenous malformation and cerebral aneurysms]

The association of an arteriovenous malformation (AVM) and a cerebral aneurysm is not so rare. Many reports have analyzed its localized relationship and studied hemodynamically the development of the cerebral aneurysm. However its therapeutic measures have not been established so far. At this time, authors have experienced 9 cases of AVM associated with cerebral aneurysm, and have studied suitable therapeutic measures. All 9 cases developed with intracranial hemorrhage, and in 6 of 9 cases, cerebral aneurysm was recognized in the feeding arteries or feeding system of the AVM (Group I). In the other 3 cases, localization of cerebral aneurysm was hemodynamically considered to have less of a relationship with AVM (Group II). It was characteristic that cerebral aneurysm in Group I was multiple, and developed frequently in the peripheral regions of the cerebral artery, especially in feeding system of the AVM itself. An operation was carried out in all 9 cases, and in Group I, 2 of 6 cases were operated on in one stage. The other 4 cases because of difficulty of management in the same operative field, were divided into two stages. In cases with clearly hemorrhagic sources, operation was firstly performed on the hemorrhagic source, and its residual focus was operated on after several months. However, in cases with unknown hemorrhagic source, cerebral aneurysm existing on the proximal side was operated on firstly. On the other hand, in Group II, when the operation was performed at one or two stages, the hemorrhagic source was dealt with first.(ABSTRACT TRUNCATED AT 250 WORDS)

Automatic implantable cardioverter defibrillator: report of the first two implants in Hawaii

Sudden cardiac death is the major cause of death in the United States today, claiming over 400,000 victims each year, or one per minute. In the majority of cases, the underlying mechanism is malignant ventricular tachyarrhythmia, with the common substrate being abnormal myocardium from ischemic heart disease or congestive cardiomyopathy.

[Malignant melanoma in the anorectal region--a report of two cases]

Case 1. A 61-year-old male, suffering from an anorectal tumor with anal bleeding, underwent an abdominoperineal rectal amputation with an R3 lymphadenectomy. The tumor was a Stage I (H0, P0, N0, S0) malignant melanoma. Despite DAV (DTIC, ACNU, and VCR) therapy, liver metastasis was detected 1 year later and the patient died 1.5 years after the operation. Case 2. A 80-year-old female, complaining of bloody stool, was diagnosed to have an anorectal malignant melanoma. She was at Stage IV and underwent an abdominoperineal rectal amputation with an R3 lymphadenectomy. The tumor 4.5 X 2.7 X 1.2 cm in size, was diagnosed to be at Stage IV (pm, n2+). She is still alive 4 years later without having received sufficient chemotherapy.

Cure of advanced gastric cancer by combined chemotherapy with cisplatinum, mitomycin C, and 5-fluorouracil

A 55-year-old female, in which an unresectable Borrmann II-type gastric cancer (moderately differentiated adenocarcinoma) extending from vicinity of the cardia to the lower portion of the corpus, with direct invasion into the pancreas and extensive lymph node metastases, confirmed by laparotomy, was treated postoperatively by 3 courses of chemotherapy with cisplatinum in combination with mitomycin C and 5-fluorouracil. A complete response was confirmed by roentgenography and endoscopy, and, at 4 months after the first operation, a total gastrectomy with radical lymphadenectomy was performed successfully. Cancer cells were not detectable histologically in the stomach specimen and in all the lymph nodes removed. One year and 5 months after the second operation she is well, showing no sign of recurrence.

[Experience with CDDP therapy in advanced and recurrent gastric cancer cases]

For 3 years beginning in 1984, 14 advanced and recurrent gastric cancer cases with measurable lesions (8 unresected cases, 3 cases of recurrence, 2 cases with non-curative resection, 1 case of no operation) were treated by CDDP therapy alone or in combination with other chemotherapies. CR was obtained in 2 of the 8 non-resected cases, radical gastrectomy being feasible in these 2 cases by second-look operation. Five of the 8 cases showed PD, and in 1 case the effect was rather obscure. One of the 2 non-curative resection cases achieved PR, and the other case was MR. One of the 3 recurrent cases was NC, the remaining cases being PD. The one case given no operation showed PD. Overall effectiveness of CDDP therapy for advanced and recurrent gastric cancer cases was seen in 3 (21.4%) of the 14 cases. All of these 3 cases showing effective CDDP therapy was elevated serum CEA values before the therapy, which was markedly reduced after starting the therapy, the reduction rate being very remarkable.