Novel flushing provoked by volatile anesthetics in Mastomys natalensis bearing a transplantable substrain of gastric carcinoid that predominantly secretes serotonin

A tumor substrain secreting a large amount of serotonin [5-hydroxytryptamine (5-HT); CAS: 50-67-9; 3-(2-amino-ethyl)indol-5-ol] and a minute amount of histamine (CAS: 51-45-6) has been isolated from the previously established strain of transplantable gastric carcinoid of Mastomys (Praomys) natalensis secreting both histamine and 5-HT. Mastomys bearing a large growing transplant and excreting a large amount of 5-hydroxy-indoleacetic acid [(5-HIAA) CAS: 54-16-0] were associated often with reddening of the nose, lower lip, auricles, hands, and feet. Soon after the animals were anesthetized by ether or other volatile anesthetics, the tinges of red of the above-mentioned exposed parts abruptly turned bright red and rapidly spread over the neck, upper chest, and epigastric area. The reddening was transient, lasting 1.5-5 minutes, thereby fulfilling the criteria of flushing. The severity of ether-provoked flushing in tumor-bearing Mastomys paralleled the urinary excretion levels of 5-HIAA. The ether-provoked flushing was prevented completely by sc injection of either ketanserin (150 micrograms) or somatostatin (20 micrograms). The same ether-provoked flushing as found in tumor-bearing Mastomys could be reproduced in normal ones by constant infusion of 20 mg 5-HT/kg/24 hours (i.e., doses comparable to those released from a transplanted tumor) through an osmotic minipump implanted subcutaneously.

Production of serotonin by a transplantable strain of histamine-producing primary gastric carcinoid of Mastomys natalensis

Two biochemically distinguishable transplantable tumor strains (A and B) were established from a primary gastric carcinoid of Mastomys secreting histamine alone. Strain A in the third generation acquired a new ability to produce serotonin [5-hydroxytryptamine (5-HT)] and retained endocrine activities to produce both histamine and 5-HT through the following subpassages, whereas strain B (like the primary tumor) continued to produce histamine alone. The findings were further supported by the immunohistochemical demonstration of 5-HT-containing tumor cells in strain A after generation 3 and the absence of such cells in strain B and also by the ultrastructural demonstration of tumor cells containing pleomorphic secretory granules in strain A after the third generation but not in strain B. Sixteen samples of Formalin-fixed, paraffin-embedded primary gastric carcinoids of Mastomys were stained by the same immunohistochemical method for 5-HT detection. The positively stained tumor cells were demonstrated in 4 tumor samples, though they were scantily distributed in tumor parenchyma except for 1 metastasizing tumor. 5-HT-producing tumor cells appeared through many proliferative cycles of the deranged histamine-producing cells. The endocrinologic similarity was noted between this transplantable tumor strain and a specific type of gastric carcinoid in humans, and the possible histogenesis of the latter tumor was discussed on the basis of data obtained from the present transplantation experiments.

[Problems of early diagnosis of pancreatic cancer and evaluation of various morphological studies]

Clinical symptoms and abnormality of laboratory examinations in 62 patients with proven pancreatic carcinoma were studied. The following indications for detailed examination of the pancreas have been evolved: (1) vague abdominal symptoms, (2) jaundice, (3) abnormalities of laporatory examinations including serum LAP, ALP, amylase and cholinesterase level, and abnormal GTT. In the jaundiced patient the initial examination is US followed by PTCD to relieve the jaundice, and then angiography to assess resectability of the tumor. In the non-jaundiced patient US is used as a screening procedure. Should this be abnormal a lesion may be confirmed by CT. If not ERCP is indicated when there is some distinct reason to suspect pancreatic disease. If ERCP reveals abnormality then angiography is performed to determine whether the lesion is benign or malignant, and if malignant it is resectable or not. In the period of 1968 and 1981, 112 proven pancreatic carcinomas were studied. Overall resectability was 26%. Thirty tumors were less than 3 cm and the smallest lesion measured 1.2 cm.

Operative procedure and indications for surgical management of pulmonary metastasis of choriocarcinoma

From 1961 to 1977, thoracotomy was performed on 19 patients with pulmonary metastasis of choriocarcinoma in Nagoya University with regard to the role of thoracotomy in management of pulmonary metastasis of choriocarcinoma. Our surgical indications for the disease are: 1) the patients must be a good risk for surgical intervention. 2) The primary malignancy be controlled. 3) Evidence of pulmonary metastasis be limited to the lung. 4) The urinary human chorionic gonadotropin (hCG) titers should be controlled at low levels below 1000 mIU/ml by preoperative chemotherapy. At levels below 200 mIU/ml, the indication for surgery will be assessed by the cellular response to chemotherapeutic agents. As an operative procedure, in view of a low incidence of lymph nodes metastases, extended pulmonary surgery appears to be unnecessary providing that the gross pulmonary lesion is removed by partial resection of the lung or lobectomy. Postoperative adjuvant chemotherapy is required to induce a complete remission of the choriocarcinoma.

Esophageal cyst, a case report and a review of the literature

The esophageal cyst is a rare disease only 20 cases of which have been reported in the literature in Japan. We recently treated such a patient and at thoracotomy, we found the cyst to be located the submucosal layer of the esophagus. The cyst could be easily extirpated and the patient made an uneventful recovery. Gross findings revealed thick, yellow and mucus-like contents inside the cyst. Microscopically, the cyst was lined with ciliated columnar epithelium and there was no evidence of cartilage. The 21st such occurrence in Japan is reported herein and a discussion is made of related literature.