Rebamipide attenuates gastric microcirculatory disturbances in the early period after thermal injury in rats

In our previous study we showed that rebamipide attenuated gastric erosions and active oxygen species released only from the gastric mucosa and not from circulating leukocytes after thermal injury. This study was designed to examine whether rebamipide affects the potential of active oxygen generation from circulating leukocytes, and attenuates microcirculatory disturbance caused by thermal injury to skin. Rats were anesthetized and a 30% full skin-thickness dorsal burn was inflicted. Microvascular images and leukocytes were observed using in vivo microscopy. Endothelial damage was assessed by monastral blue B deposits. Active oxygen species were measured by the chemiluminescence method. Rebamipide (100 mg/kg) decreased leukocyte rolling and monastral blue B deposits in venules but did not improve arteriolar contractions 15 min after thermal injury. These results suggest that rebamipide preserves gastric microcirculation possibly through inhibition of leukocyte adhesion and endothelial damage caused by thermal injury to skin.

Trends of average intake of macronutrients in 47 prefectures of Japan from 1975 to 1994--possible factors that may bias the trend data

To describe the geographical patterns and trends of macronutrient intake in Japan for the recent 20 years, we analyzed the data sets of the National Nutrition Surveys (J-NNS). First, we calculated regression coefficients for survey year by prefecture for energy, protein, fat, and carbohydrate intake. These results, however, could be affected by the changes in age and sex distributions of the survey samples. Secondly, as the food consumption data were based on household as a unit, we used proportions of the subjects who belong to age-specific groups and female subjects in a sub-sample for each prefecture in a given year for adjustment by general lineal model. As a result, 1% increase in the subjects aged 1-4, 10-19 and 65- years and female subjects was equivalent to the changes in average energy intake by -5.88, +2.27, -1.45 and -1.62 kcal, respectively. After the adjustment for age and sex, number of significant negative coefficients among 47 prefectures decreased for energy and carbohydrate intake, and that of positive coefficients increased for fat intake. This suggested that unadjusted trend data might lead to an overestimation of decreasing trends of energy and carbohydrate intake, and an underestimation of increasing trend of fat intake in the recent 20 years.

Antitumor activity of murine monoclonal antibody NCC-ST-421 on human cancer cells by inducing apoptosis

BACKGROUND

The murine monoclonal antibody NCC-ST-421 (ST-421) recognizes dimeric Le(a) antigen expressed on gastrointestinal cancer cells.

MATERIALS AND METHODS

Direct antitumour activity of ST-421 was evaluated using dimeric Le(a) positive cell lines Colo 205, Colo 201, HT-29 and WiDr; and negative cell lines MX-1 and K562.

RESULTS

While time- and concentration-dependent antitumour activity was observed against Colo 205 and Colo 201, no antitumour activity was detected against the other cell lines tested in an in vitro cytotoxicity assay. When ST-421 was administered intraperitoneally daily for 2 weeks to severe combined immunodeficient (SCID) mice transplanted with tumour xenografts, inhibition of tumour growth was observed against Colo 205, and to a lesser extent HT-29 and WiDr. Anti-asialo GM1 antibody did not block this antitumour activity, suggesting ST-421 has a direct cytotoxic effect. The degree of antitumour activity of ST-421 dependent on the grade of Le(a)-expression as detected by immunohistochemical staining.

CONCLUSIONS

Flow cytometric and immunohistochemical analysis suggests the induction of apoptosis may play a key role in the direct antitumour activity of ST-421 on Colo 205 cells.

Lymph node metastasis of early gastric cancer with submucosal invasion

BACKGROUND

A clinicopathological study of early gastric cancer with submucosal invasion was carried out in relation to lymph node metastasis.

METHODS

A retrospective study was conducted of 245 patients with submucosal gastric cancer treated by gastrectomy combined with D2 lymph node resection between 1985 and 1994 in a university hospital.

RESULTS

Lymph node metastasis was observed in 34 patients (14 per cent). The mortality rate due to recurrence in patients with lymph node metastasis (three of 34) was significantly higher than in those without lymph node metastasis (five (2 per cent) of 211) (chi2 = 3.95, 1 d.f., P < 0.05). Tumour size, depth of invasion, lymphatic involvement of cancer cells and preoperative diagnosis of advanced cancer correlated significantly with the presence of lymph node metastasis. When the submucosal carcinomas were classified into three categories according to depth of invasion by dividing the submucosal (sm) layer into three equal parts, sm1, sm2 and sm3, the incidence of lymph node metastasis increased from 2 per cent to 12 and 20 per cent respectively.

CONCLUSION

When the pathological report reveals sm1 invasion after laparoscopic or endoscopic surgery, reoperation should not be necessary because sm1-carcinomas with diameters of less than 2 cm do not usually metastasize to the lymph nodes.

[Recent progress of matrix metalloproteinase (MMP) research and its clinical application for cancer therapy]

The matrix metalloproteinases (MMPs) are a family of secreted and membrane-bound zinc-endopeptidases. These enzymes are capable of degrading the extracellular matrix, including collagens, laminin, proteoglycan and fibronectin. In some human cancers, a positive correlation has been demonstrated between MMP expression and the likelihood of developing metastasis. An imbalance between MMPs and the tissues inhibitor of metalloproteinases (TIMPs) may play a significant role in the invasive phenotype of cancers. Although TIMPs have been shown to inhibit tumor metastasis in some in vivo models, they are not suitable for pharmacologic applications due to their short half-life in vivo and large molecular size. In this paper, recent advances in MMP research and reports of clinical applications of synthetic MMP inhibitors for cancer patients are reviewed.

Further evidence for the value of the chemosensitivity test in deciding appropriate chemotherapy for advanced gastric cancer

BACKGROUND

The chemosensitivity test using the MTT endpoint is useful in predicting chemosensitivity.

PATIENTS AND METHODS

One hundred twenty-eight patients with advanced gastric cancer were enrolled in the study, which mitomycin C (MMC), doxorubicin (DXR), 5-fluorouracil (5-FU), and cisplatin (DDP) were used.

RESULTS

The corresponding efficacy rates were 12.5% for MMC, 6.3% for DXR, 5.4% for 5-FU and 13.4% for DDP. The overall predictive accuracy was 78% in the patients with measurable lesions. Among the patients without measurable lesions, 21 were treated with a curative operation, and 33 with a non-curative operation. In those patients undergoing curative surgery, the "adapted" group detected by MTT assay survived longer than "non-adapted" cases (p < 0.05).

CONCLUSIONS

The present study provides further evidence that the chemosensitivity test may be useful for evaluating appropriate chemotherapy for advanced gastric cancer.

[Laparoscopic surgery for early gastric cancer--its advantages and pitfalls]

We have successfully established two different laparoscopic procedures for early gastric cancer since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method and laparoscopic intragastric mucosal resection. The indication is as follows; (A) mucosal cancer, (B) < 25 mm, if the lesion is elevated type, (C) < 15 mm and Ul (-), if the lesion is depressive type. The advantages of these methods are; 1) minimally invasiveness, 2) sufficient surgical margin, 3) feasibility of detailed histology, 4) feasivility of perigastric lymph node dissection. In contrast, there are several problems to be solved, which are; 1) preoperative diagnostic accuracy of the depth of cancer invasion, 2) possibility of reoperation because of sm invasion or lymphatic or venous invasion in final histology, 3) possibility of postoperative stenosis after laparoscopic intragastric mucosal resection for the lesion near the cardia, 4) incidence of metachronous multiple gastric cancer. In conclusion, if the indication is properly selected, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.

MKT-077, localized lipophilic cation: antitumor activity against human tumor xenografts serially transplanted into nude mice

BACKGROUND

In in vitro experiments, the localized lipophilic cation, MKT-077, demonstrated time- and concentration-dependent antitumor activity. In the present experiment, the in vivo antitumor activity of MKT-077 was evaluated using human tumor xenografts serially transplanted into nude mice.

MATERIALS AND METHODS

The antitumor efficacy of MKT-077 against five xenografts inoculated subcutaneously into nude mice was studied. Treatment with MKT-077 was initiated when the tumors started exponential growth. The antitumor activity of MKT-077 was assessed by a) the lowest value of the relative mean tumor weight of the treated:control tumors (T/CRW), where relative weight (RW) represented the change from baseline weight; and by b) the unadjusted weight of treated tumors at the end of the experiment.

RESULTS

When MKT-077 was administered continuously using the Osmotic Micropump, antitumor activity was positively correlated with exposure time and drug concentration from 7.5 to 40 mg/kg/day. The maximum tolerated dose was 20 mg/kg/day for 7 days. Co-4 (human colon cancer), St-4 (human gastric cancer), and CRL1420 (human pancreatic cancer) were evaluated as sensitive to MKT-077 in tested 5 strains.

CONCLUSION

The antitumor activity of MKT-077 was confirmed using human tumor xenografts in nude mice.

Suppressed production of nitric oxide as a cause of irregular constriction of gastric venules induced by thermal injury in rats

Microcirculatory disturbance is a crucial step in development of gastric mucosal lesions. In this study we investigated the influence of nitric oxide (NO) on the irregular constriction of gastric venules observed in rats subjected to thermal injury. Male Wistar rats were anesthetized and a 30% full skin thickness dorsal burn was inflicted. Microvascular images in the submucosal layer and basal region of the gastric mucosa were obtained through an intravital microscope. Distribution of constitutive-type nitric oxide synthase (cNOS) was observed by the immunofluorescence method. Venule walls were basically smooth in the control group (no injury), whereas irregular constrictions tended to be observed in the 5-h group (5 h after thermal injury). Venule diameter was significantly smaller in the 5-h group. In the control group, cNOS-associated fluorescence was found on the venule endothelium, whereas it was almost negligible after thermal injury. A NO donor, 3-morpholinosydnonimine hydrochloride, simultaneously diminished the thermal injury-associated venule constriction and irregularity of venule walls. Therefore, the present study suggests that venule constriction, which is observed 5 h after thermal injury, is related to decreased NO production by endothelial cNOS and is a cause of irregularity of the venule walls.

Matrix metalloproteinase gene expression in chronic gastric ulcer: a potential role of eosinophils in perforation

Gene expression of matrix degrading enzymes was investigated in surgical specimens of perforated gastric ulcers. In these ulcers, the inflammatory cells infiltrating into the granulation tissue were granulocytes, particularly eosinophils. The extracellular matrix of the stomach wall consists mainly of collagen types I and III, which are selectively degraded by matrix metalloproteinase-1 (MMP-1). MMP-1 mRNA was detected in the cytoplasm of infiltrating cells, suggesting that eosinophils play an important role in ulcer recurrence and in perforation of the stomach wall. The degree of eosinophil infiltration into an ulcer base may be a useful marker for the risk of perforation. Patients showing this marker may benefit from a prophylactic therapy for preventing severe complications. The control of MMP gene expression represents a potential strategy for the treatment of recurrent gastric ulcer.

A protease inhibitor attenuates gastric erosions and microcirculatory disturbance in the early period after thermal injury in rats

The effects of camostat mesilate, a synthetic serine protease inhibitor on gastric microcirculation and active oxygen species generated by leucocytes from the gastric and jugular veins in the early period after thermal injury were assessed. Male Wistar rats were anaesthetized and a 30% full skin-thickness dorsal burn was inflicted. Camostat mesilate (100 mg/kg) was dissolved in distilled water and administered orally to rats 40 min before thermal injury (the camostat group). The control animals (the vehicle group) were administered distilled water orally. Rolling leucocytes as well as Monastral blue B deposits in venules were observed using in vivo microscopy. Active oxygen species were measured by chemiluminescence. Camostat mesilate decreased the total length of gastric erosion, venular deposits of Monastral blue B, and rolling of leucocytes in venules, and relatively increased luminol-dependent chemiluminescence activity generated by zymosan-stimulated leucocytes 15 min after thermal injury. These results suggest that serine proteases are involved in the formation of gastric erosions and gastric microcirculatory disturbance in the early period after thermal injury.

[Laparoscopic wedge resection of the stomach for early gastric cancer using a lesion-lifting-method: curative and minimally invasive treatment]

Thirty-eight patients with early gastric cancer have been successfully treated by laparoscopic wedge resection of the stomach in our institute since March 1992. Our indication of the surgery is as follows: 1) preoperatively diagnosed mucosal cancer, 2) < 25 mm, if the lesion is elevated type, and 3) < 15 mm and no ulcer scar, if the lesion is depressed type. After laparoscopic exposure of the gastric wall around a cancerous lesion, a sheathed needle was inserted into the stomach through the abdominal wall at the vicinity of the lesion under gastroscopy guidance. A small metal rod was introduced into the stomach near the lesion through the outer sheath. While the lesion was lifted up precisely with the support of the metal rod, wedge resection of the stomach was performed using an endoscopic stapler (lesion-lifting method). Perigastric lymph nodes could be also resected when necessary. There was no intraoperative and postoperative complication, and no mortality. The patients were discharged within 5 days after surgery uneventfully. The resected specimens were 50 to 110 mm in diameter, and there was a sufficient surgical margin (16 +/- 5mm). All patients have survived during the 2 to 60 months follow-up period. There has been one recurrence and one separate occurence of early gastric cancer in the series, which were curatively treated by gastrectomy. Advantages of the surgery are as follows: 1) it is minimally invasive, 2) most of the stomach is preserved, 3) a sufficient surgical margin can be obtained, and 4) a detailed histologic examination is feasible. If the indication is selected properly, this laparoscopic surgery can be a curative and minimally invasive treatment for early gastric cancer.

[Limited operation for lung cancer: wedge resection using stapling device]

We employed wedge resection using stapling device for peripheral, clinical stage I lung carcinoma in selected poor-risk patients. Out of 10 patients, four developed local recurrence and one had the second primary in the same lobe resected. Compared with patients having lobectomy with 91% of a recurrence free rate in three years, those who underwent wedge resection had the lower rate of 53%. We conclude that wedge resection using stapling device cannot be an acceptable procedure even for poor-risk patients.

Availability of nasal mask BiPAP systems for the treatment of respiratory failure after cardiovascular surgery

BACKGROUND

The availability of nasal mask bi-level positive airway pressure (BiPAP) support in managing respiratory failure following cardiovascular surgery was studied.

MATERIALS AND METHODS

BiPAP support was used for eight patients requiring postoperative prolonged respiratory support of 72 hours or longer. Their mean age was 65 years of age and the mean periods of postoperative endotracheal intubation was 12+/-5 days. BiPAP support was removed within 48 hours in six out of eight patients. Reintubation of an endotracheal tube was not necessary in all eight patients after the BiPAP treatment.

RESULTS

The respiratory rates during the BiPAP management remained unchanged. The values of the respiratory index significantly (p<0.01) improved after BiPAP management (1.5+/-0.2 --> 0.9+/-0.2). A-aDO2 and Qs/Qt decreased (p<0.1) after the BiPAP management. There were no significant differences in central venous pressure and circulatory states during BiPAP support.

CONCLUSIONS

In conclusions, BiPAP support is a noninvasive management technique for postoperative respiratory failure and may also prevent prolonged endotracheal intubation.

Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis

Pulmonary aspergillosis associated with old tuberculosis is generally resistant to treatment. Thus, if patients are treated only with conservative therapy, their condition continues to deteriorate due to repetitive hemoptysis, and may even become critical. Surgical treatment is required for these patients; however, it is extremely difficult to resect the lesion due to severe adhesions to the chest wall and vascular proliferation surrounding the lesion. We performed preoperative arterial embolization, achieving good results in three patients with hemoptysis caused by pulmonary aspergillosis. The feeding arteries were embolized using microcoils and/or gelatin sponges, and a lobectomy was safely carried out in all patients. We concluded that preoperative arterial embolization is a safe and effective technique to prevent massive hemorrhage occurring at the time of surgery.

Expression of matrix metalloproteinase-1 mRNA related to eosinophilia and interleukin-5 gene expression in head and neck tumour tissue

In situ hybridization (ISH) of the expression of matrix metalloproteinase-1 (MMP-1) in areas of local invasion of head and neck tumours was performed. Expression of MMP-1 mRNA was found in stromal inflammatory cells adjacent to the tumour nests, apparently in eosinophils. MMP-1 mRNA expression was seen only in cases with moderate or greater stromal eosinophilia. MMP-1 mRNA was detected in benign papilloma and verrucous carcinoma. In squamous cell carcinomas, expression of the gene was detected only in well-differentiated cases. Expression of MMP-1 mRNA was not related to the grade of malignancy, and appeared in stromal eosinophils, suggesting to us that it is involved in a remodelling process in the reaction of the host to tumour invasion. ISH examination of the expression of interleukin-5 (IL-5), the activating factor for eosinophils, was also performed. In the tumour, its expression was consistent with the location of eosinophils, as with MMP-1 mRNA, suggesting an autocrine mechanism.

The role of stromal cells in the expression of interstitial collagenase (matrix metalloproteinase-1) in the invasion of gastric cancer

BACKGROUND AND OBJECTIVES

In one of the steps of tumor invasion and metastasis, tumor cells must invade surrounding tissues and degrade the components of the basement membranes. Interstitial collagenase (matrix metalloproteinase-1: MMP-1) has been also investigated in relation to cancer invasion and metastasis.

METHODS

We investigated the formation and mechanism of MMP-1 expression using gastric cancer cell lines and gastric fibroblasts derived from normal gastric mucosa by ELISA and immunohistochemistry.

RESULTS

Production of MMP-1 protein in gastric fibroblasts was stimulated significantly by adding the conditioned medium of MKN-74. Localization of MMP-1 protein in the xenografted gastric cancer cell lines was heterogeneous according to different cell lines.

CONCLUSIONS

These results suggested that the production of MMP-1 protein in tumor invasion was regulated by interaction between stromal cells, particularly fibroblasts, and tumor cells.

Left-sided approach to renal cell carcinoma tumor thrombus extending into suprahepatic inferior vena cava by resection of the left caudate lobe

A new operative approach to resecting tumor thrombus originating from a right renal cell carcinoma extending into the suprahepatic inferior vena cava (IVC) is reported. Complete local control of the IVC must be obtained above and below the tumor thrombus to remove it under direct vision. The caudate lobe of the liver was resected to expose the retrohepatic IVC and open the lesser omentum. The subhepatic IVC was encircled just below the confluence of the hepatic veins. Caval tumor thrombus was removed en bloc, including the right kidney, by use of the total hepatic vascular exclusion technique (THVE) and IVC exclusion. The retrohepatic IVC was clamped just below the confluence of the hepatic veins once the thrombus was removed, and the suprahepatic IVC clamp was then released and the THVE was terminated. The sequential clamping from the suprahepatic IVC to the retrohepatic IVC below the confluence of the hepatic veins shortened the THVE time.

[Jejunal pouch interposition after total gastrectomy]

The results and procedures of interposed jejunal pouch after total gastrectomy for gastric cancer are reported. Basic requirements of reconstruction after total gastrectomy are 1) formation of a food reservoir, 2) maintenance of duodenal continuity, 3) avoidance of reflux esophagitis, 4) gradual emptying of reservoir into the small intestine. Since 1950's, several procedures of gastric substitutes have been reported. But they were not widely performed. Because scientific evaluation of the value of gastric substitutes was difficult and the operative procedures were time consuming and complicated. With an increasing ratio of early gastric cancer in 1990's, the importance of post-operative QOL, such as food intake and body weight maintenance, in patients after total gastrectomy has been recognized. Our procedure is a double lumen jejunal pouch distal to a interposed jejunum. The length of interposed jejunum is 20 cm and that of pouch is 10 cm. Using surgical staplers, this procedure is safe and simple. Jejunal pouch interposition leads to a satisfactory symptomatic and nutritional result in gastrectomized patients.

[Clinical criteria of chemosensitivity test]

Chemosensitivity test is useful in evaluating the appropriate cancer chemotherapy for solid tumors which are less sensitive to conventionally available antitumor agents. Most of assays used in clinics are in vitro assay, in which the cutoff concentration and contact time should be determined to mimic the clinical response of the chemosensitivity test. Since the antitumor effect of most of antitumor agents depends on their concentration x contact time, and the contact time will be determined according to the assay, the cutoff concentration will be calculated from the cumulative efficacy curve or 50% inhibitory concentration and in vivo response of human tumor xenografts in nude mouse. The clinical result obtained from chemosensitivity test was discussed.

Surgical management of gastric leiomyosarcoma: evaluation of the propriety of laparoscopic wedge resection

Laparoscopic surgery has been applied to malignant gastric tumors. To evaluate the propriety of laparoscopic wedge resection for gastric leiomyosarcoma it is necessary to question whether lymph node dissection is necessary for the surgical management of gastric leiomyosarcoma. A retrospective study on open surgery cases of gastric leiomyosarcoma was performed to address this issue. The clinical records of 28 patients with gastric leiomyosarcoma who had had surgery were examined. The patients who underwent open surgery were divided into a systematic lymph node dissection (SLND) group (n = 9) and a nondissection (non-D) group (n = 19). No patient had lymph node metastasis at the time of operation or recurrence, and statistical analysis showed no difference between the SLND and non-D groups in terms of survival rates. These data suggest that SLND might not be necessary for the surgical management of gastric leiomyosarcoma and that laparoscopic wedge resection of the stomach can be considered a first-line treatment for gastric leiomyosarcoma.

Expression of interstitial collagenase (matrix metalloproteinase-1) in gastric cancers

The expression of matrix metalloproteinase-1 (MMP-1) gene and the presence of MMP-1 protein in gastric cancer were examined by in situ hybridization and immunohistochemistry. Expression of the interstitial collagenase (MMP-1) gene was detected within the stroma of the neoplastic glands, and infiltration of eosinophils was observed to be associated with regions of MMP-1 gene expression. The degree of eosinophilic infiltration correlated with the level of MMP-1 mRNA expression. Immunostaining showed localization of MMP-1 protein in the stromal cells, and additionally in the neoplastic glands. These findings indicate that the stromal cells may play an important role in the expression of MMP-1, and suggest a pathophysiological role for MMP-1 in the invasion and metastasis of gastric cancer.

Difference in gene expression for matrix metalloproteinase-1 between early and advanced hepatocellular carcinomas

The histological observation that well-differentiated cancer cells in early hepatocellular carcinoma (HCC) invade portal tracts and/or fibrous bands and that these fibrous tissues then disappear suggests the participation of matrix metalloproteinase-1 (MMP-1) in the degradation of fibrous tissue. To confirm this hypothesis, the authors investigated the localization of both the MMP-1 protein and its messenger RNA (mRNA) in early HCC immunohistochemically and by in situ hybridization using complementary DNA (cDNA) and synthetic antisense probe of MMP-1; they then compared the results with those in advanced HCC. MMP-1 gene transcripts and protein were observed in well-differentiated cancer cells of early HCC but not in moderately or poorly differentiated cancer cells. Thus, cancer cells producing MMP-1 in early HCC may destroy the portal tract tissue adjacent to the cancer lesion and/or the fibrous band of cirrhosis. These results seem to have demonstrated a difference in the mechanism of cancer growth and invasion between early and advanced HCCs.

[Laparoscopic surgery for early gastric cancer--its advantage and pitfall]

We have successfully treated 50 patients with early gastric cancer by using two different laparoscopic procedures since March 1992. which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 33) and laparoscopic intragastric mucosal resection (n = 17). The indication is as follows; (A) mucosal cancer, (B) < 25 mm, if the lesion is protruded type, (C) < 15 mm and Ul(-), if the lesion is depressive type. The advantages of these methods are; 1) minimally invasiveness. 2) sufficient surgical margin, 3) feasibility of detailed histology, 4) feasibility of perigastric lymph node dissection. In contrast, there are several problems to be solved, which are; 1) preoperative diagnostic accuracy of the depth of cancer invasion, 2) possibility of reoperation because of sm invasion or lymphatic or venous invasion in final histology, 3) possibility of postoperative stenosis after laparoscopic intragastric mucosal resection for the lesion near the cardia, 4) incidence of metachronous multiple gastric cancer.

Malfunctioning Starr-Edwards mitral valve 21 years after installation

Two cases of malfunctioning Starr-Edwards cloth-covered mitral valve prostheses requiring reoperation are presented. Both cases underwent successful surgical repair 21 years after the valve replacement. The causes were a disturbance of the poppet during the opening movement due to excessive tissue ingrowth and a paravalvular leak associated with a tear of the valve seat. Replacement of the Starr-Edwards valve prosthesis more than 20 years after the initial installation has not been reported.

Interferons alpha-2a and beta increase the antitumor activity, detected by MTT assay, of 5-fluorouracil against experimental and clinical human gastrointestinal carcinomas

In order to investigate the combined antitumor activity of 5-fluorouracil (5-FU), and recombinant human interferon alpha 2a (IFN alpha) or human fibroblastoid interferon beta (IFN beta), the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was carried out using a cultured human colon cancer cell line (C-1) and fresh surgical specimens of gastric and colon carcinomas. IFNs did not show positive antitumor activity against C-1 cells, whereas 5-FU showed time- and concentration-dependent antitumor activity against C-1 cells. Furthermore, the antitumor activity of 5-FU on C-1 cells was augmented by IFN alpha or beta. When 5-FU (50 micrograms/ml) with IFN alpha (50 IU/ml). or IFN beta (50 IU/ml) was applied for the MTT assay with 48 hours incubation of fresh surgical specimens of gastric and colon carcinomas, the inhibition rates increased by 10% in 9 of 21 gastric specimens and in 18 of 36 colon carcinomas for IFN alpha (47.4% or 27/57), and in 8 of 15 gastric specimens and in 15 of 28 colon carcinomas for IFN beta (53.5% or 23/43). These results suggest that the chemosensitivity to 5-FU of human gastric and colon carcinomas is increased in the presence of IFNs, without involvement of the host-mediated immune system, and that this combined effect can be predicted by the MTT assay in vitro.

Benign tumors of the lung: a 20-year surgical experience

In the following report, we describe our investigation of the diagnosis and operative methods for benign tumors of the lung, in which the surgical treatment was selected due to suspicious malignancy. This study included 22 patients with benign tumors. The patients' mean age was 55 years old. The histological diagnosis was made postoperatively prior to 1985 and intraoperatively after 1986. Hamartoma was the most common of the benign tumors. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. Of the patients with benign tumors, 78% underwent lobectomy or segmentectomy prior to 1985, and none have undergone any invasive procedures since 1986. Malignant tumors are sometimes difficult to distinguish from benign tumors preoperatively. Therefore, intraoperative histological examinations are necessary in cases in which malignancy is suspected. In such cases, a smaller invasive procedure should be selected due to the possibility of the tumor being benign.

Left ventricular fibroma in an aged patient: report of a case

We report herein the case of a 77-year-old man with a left ventricular tumor originating from the papillary muscle of the left ventricular wall, in whom a successful tumor resection with mitral valve replacement was performed. The pathological diagnosis of the tumor was confirmed as cardiac fibroma. His postoperative course was uneventful and he is currently well with no signs of recurrence 2 years after surgery.

Hepatic embolization through extrahepatic collateral pathways after hepatic arterial embolization for the hepatocellular carcinoma

Extrahepatic collateral pathways developing after repeated transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) make therapeutic arterial embolization for recurrent lesions extremely difficult. TAE was performed through the collateral pathways using a sophisticated micro-catheter with good trackability and pushability and a coaxial system. Twenty-three TAEs were undertaken through the collateral pathways in 13 patients with recurrent HCC who had extrahepatic collateral pathways after the previous hepatic arterial TAE. There were 69 extrahepatic collateral pathways, with partially obstructed hepatic arteries. On the average, three feeding arteries were seen in the liver. The main extrahepatic collateral pathways were the inferior phrenic artery and epicholedocal artery, 18 vessels and 29 vessels, respectively, accounting for about 80% of the total collateral pathways. TAEs were successful in all cases and the number of embolized vessels was 2.1 on average. The average time of the first collateral TAE after the initial conventional hepatic arterial TAE was 2.3 years. Excellent prognosis was observed with a one-year survival rate of 77% and 3-year survival rate of 38% after the collateral TAE. We consider that collateral TAE for recurrent HCC with obstruction of the hepatic artery is the procedure of choice, is technically feasible, and provides better prognosis for the patients.

Preoperative intra-arterial infusion chemotherapy for invasive thymoma: a case report

A 24-year-old man was diagnosed as having mixed-type thymoma by preoperative percutaneous needle biopsy. A chest computed tomogram showed a tumor measuring 12x9 cm. Selective intra-arterial infusion chemotherapy was first selected because invasion to the superior vena cava was suspected. Bolus injection of 50 mg/m2 cisplatin and 20 mg/m2 adriamycin was performed once into the right internal thoracic artery. The resulting decrease in tumor size was 81%. Neither complications due to the infusion procedure nor side effects due to the anticancer drugs were encountered. An extended thymectomy with partial resection of the mediastinal pleura was safely performed. The histological diagnosis of the resected tumor was thymic hyperplasia. The patient was transferred to a radiologist for additional radiotherapy. Selective intra-arterial infusion chemotherapy for invasive thymoma is an effective therapy, producing no significant side effects and allowing safe resection.

Benign tumors and tumor-like lesions of the lung

We detail an investigation of the diagnosis and operative method for benign tumors and tumor-like lesions of the lung. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. In tumor-like lesions, the correlation of preoperative and postoperative diagnosis was poor. Since 1986, no patient with benign tumors has undergone invasive methods, but this has been required in some tumor-like lesions. Malignant tumors are easily distinguished from benign tumors but difficult from tumor-like lesions, preoperatively. Therefore, open biopsy is necessary in cases of suspicious malignancy. Then small invasive procedure should be selected due to the possibility of benign tumors.

A malignant Triton tumor in the anterior mediastinum requiring emergency surgery: report of a case

We report herein the case of a 17-year-old woman with von Recklinghausen's disease who was diagnosed as having a giant malignant Triton tumor located in the anterior mediastinum, which had adhered to the heart and the great vessels. An emergency operation was performed to relieve the tracheobronchial stenosis and congestive heart failure caused by the pressure of the tumor. Extracorporeal circulation was not required and the tumor could be excised only piece by piece. To our knowledge, this is the first report of a malignant Triton tumor being located in the anterior mediastinum.

Secundum atrial septal defect associated with mitral valve cleft: report of a case with chromosomal syndrome of trisomy 3p

A 4-year-old boy was diagnosed as having a chromosomal abnormality with trisomy 3p associated with a secundum atrial septal defect and a cleft of the anterior mitral leaflet. His craniofacial features showed microcephaly, micrognathia, ocular hypertelorism associated with epicanthus, and low-set ears. Moderate mental retardation and hypoplasia of the penis were also noted. A left ventriculogram demonstrated grade 2 mitral regurgitation according to the Sellers' classification with a prolapsing of the mitral leaflets. A cleft of the anterior mitral leaflet was detected at the time of operation. The secundum atrial septal defect was directly closed and the mitral cleft was repaired. This is the first report of trisomy 3p associated with an atrial septal defect and a mitral valve cleft.

Gastric plasmacytoma: report of a case

A 54-year-old man with primary gastric plasma-cytoma is herein reported. After the patient had been diagnosed as having malignant lymphoma by gastrofiberscopy and a radiologic upper GI examination, a total gastrectomy was performed. Both histological and immunohistochemical studies showed plasmacytoma cells infiltrating the entire stomach wall, producing IgM-lambda, and indicating a final diagnosis of primary gastric plasmacytoma. Monoclonal immunoglobulin was not detected in the serum throughout the course. The case is discussed with reference to other reported cases of primary gastric plasmacytoma.

Health information system

Outline of selected ones among a number of nationwide surveys related to health and welfare services (90 surveys as of 1995) conducted mainly by the Ministry of Health and Welfare periodically in Japan is described. That is, history, purpose, coverage, date, contents, data collection procedure, tabulation and publication were explained in regard to : (1) Population Census, (2) Vital Statistics, (3) Patient Survey, (4) Infectious Disease Surveillance System, (5) Comprehensive Survey of Living Conditions of People on Health and Welfare, (6) Census on Medical Care Institutions, (7) Hospital Report, (8) Survey on Physicians, Dentists and Pharmacists, (9) Statistical Report on Public Health Administration Services, (10) Survey on Social Welfare Institutions, and (11) National Nutrition Survey. On-line data service system of the Ministry of Health and Welfare is also briefly mentioned.

Pharmacokinetics of cis-diamminedichloroplatinum (II) given as low-dose and high-dose infusions

A pharmacokinetic analysis of cis-diamminedichloroplatinum (II) (DDP) was conducted comparing low-dose daily bolus infusions, and high-dose drip infusions. Eight patients with gastric cancer were treated with low-dose daily bolus infusions of DDP to a total daily dose of 75 mg/m2 bid for 5 days. Four patients with esophageal cancer and one patient with gastric cancer were treated with high-dose drip infusions of DDP to a total daily dose of 70-80 mg/m2. Side effects were assessed in all the patients, and the platinum concentration in plasma was determined by an atomic absorption method. The peak plasma concentration (Cmax) and area under the curve (AUC) were calculated in four cases of the low-dose therapy, and three cases of the high-dose therapy. The side effects of DDP were evaluated according to the World Health Organization (WHO) grading, paying particular attention to nausea/vomiting, appetite loss, renal toxicity, and bone marrow suppression. The incidence of nausea/vomiting and appetite loss was significantly reduced with low-dose daily bolus infusions when compared to the high-dose drip infusions. Bone marrow toxicity and renal toxicity were similar with both administration methods, although hydration was required for the high-dose drip infusions to prevent renal toxicity. The peak plasma concentration (Cmax) of total and free platinum, and the area under the curve (AUC) of total platinum, were similar with both administration methods, while the AUC of free platinum was higher with the low-dose daily bolus infusions compared to the high-dose drip infusions. The time when the concentration of total platinum was > 1 microgram per ml (holding time) was significantly longer with the high-dose drip infusions than with the low-dose daily bolus infusions. The present study suggests that low-dose daily bolus infusions of DDP would be useful in reducing gastrointestinal toxicity, without reducing the area under the curve which is important for antitumor activity.

Rapidly curable biological glue composed of gelatin and poly(L-glutamic acid)

The tissue adhesion property of a hydrogel cross-linked with water-soluble carbodiimide (WSC) was investigated and compared with that of the conventional fibrin glue. The biodegradable hydrogel was composed of gelatin and poly(L-glutamic acid) (PLGA). This study focused on the mouse skin bonding by the WSC-formed hydrogel prepared from a low-molecular-weight (Mw) gelatin whose aqueous solution did not spontaneously set to a gel at 25 degrees C, in contrast to the conventional gelatin with high Mw. At polymer concentrations lower than the incipient gelation concentration, the bonding strength of mouse skin by the WSC-cross-linked gelatin-PLGA hydrogel increased with an increase in the concentration of gelatin and PLGA, irrespective of Mw of gelatin. When compared at the highest gelatin concentration which did not cause gelation, the bonding strength of the hydrogel composed of lower Mw gelatin and PLGA was higher than that of higher Mw gelatin hydrogel with or without PLGA or the conventional fibrin glue. The mixed aqueous solution from the gelatin with Mw of 10,000 and PLGA was gelled by use of WSC as rapidly as the fibrin glue. It was concluded that the gelatin-PLGA hydrogel is a safe biological glue with the adhesion property superior to the fibrin glue.

A new biological glue from gelatin and poly (L-glutamic acid)

This study describes the potentiality of hydrogels composed of gelatin and poly(L-glutamic acid) (PLGA) as a biological glue for soft tissues and compares its effectiveness with that of a conventional fibrin glue. Water-soluble carbodiimides (WSC) were used to crosslink the aqueous mixture of gelatin and PLGA. The mixed aqueous solution of gelatin and PLGA set to a hydrogel by use of WSC as rapidly as BOLHEAL fibrin glue. An addition of PLGA to gelatin aqueous solution reduced not only its gelation time but also the WSC concentration necessary for hydrogel formation. The cured hydrogel exhibited firm adhesion to the mouse skin and other soft tissues with a higher bonding strength than BOLHEAL fibrin glue. Cohesive failure in the hydrogel was observed when the gel-tissue bond was broken, in contrast to BOLHEAL fibrin glue. The bonding strength of the gelatin-PLGA hydrogel became higher with the increasing PLGA concentration. The inflammatory reaction around the gelatin-PLGA hydrogel subcutaneously implanted in mice was mild, and the hydrogel was gradually absorbed with time in vivo. A toxicity test demonstrated that the concentration of WSC necessary as a biological glue was low enough not to induce its toxicity.

Pharmacokinetics of cis-diamminedichloroplatinum (II) given as low-dose and high-dose infusions

A pharmacokinetic analysis of cis-diamminedichloroplatinum (II) (DDP) was conducted comparing low-dose daily bolus infusions, and high-dose drip infusions. Eight patients with gastric cancer were treated with low-dose daily bolus infusions of DDP to a total daily dose of 75 mg/m2 bid for 5 days. Four patients with esophageal cancer and one patient with gastric cancer were treated with high-dose drip infusions of DDP to a total daily dose of 70-80 mg/m2. Side effects were assessed in all the patients, and the platinum concentration in plasma was determined by an atomic absorption method. The peak plasma concentration (Cmax) and area under the curve (AUC) were calculated in four cases of the low-dose therapy, and three cases of the high-dose therapy. The side effects of DDP were evaluated according to the World Health Organization (WHO) grading, paying particular attention to nausea/vomiting, appetite loss, renal toxicity, and bone marrow suppression. The incidence of nausea/vomiting and appetite loss was significantly reduced with low-dose daily bolus infusions when compared to the high-dose drip infusions. Bone marrow toxicity and renal toxicity were similar with both administration methods, although hydration was required for the high-dose drip infusions to prevent renal toxicity. The peak plasma concentration (Cmax) of total and free platinum, and the area under the curve (AUC) of total platinum, were similar with both administration methods, while the AUC of free platinum was higher with the low-dose daily bolus infusions compared to the high-dose drip infusions. The time when the concentration of total platinum was > 1 microgram per ml (holding time) was significantly longer with the high-dose drip infusions than with the low-dose daily bolus infusions. The present study suggests that low-dose daily bolus infusions of DDP would be useful in reducing gastrointestinal toxicity, without reducing the area under the curve which is important for antitumor activity.

[Laparoscopic curative surgery for early gastric cancer]

We have successfully treated 40 patients with early gastric cancer by using two different laparoscopic procedures since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 25) and laparoscopic intragastric mucosal resection (n = 15). The indication is as follows; 1) mucosal cancer, 2) < 25 mm, if the lesion is protruded type, 3) < 15 mm and Ul(-), if the lesion is depressive type. All patients were discharged within 4-8 days uneventfully. The resected specimens were 66 +/- 16 mm and 48 +/- 8 mm in diameter respectively, and had a sufficient surgical margin horizontally (16 +/- 5 mm, 8 +/- 4 mm) and vertically. Histology revealed they were all curative surgeries except one case in whom an additional gastrectomy with lymph node dissection by lapalotomy was required one month after surgery because lymphatic invasion had been revealed by pathology. In conclusion, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.

[Laparoscopic surgery for early gastric cancer]

We have successfully treated 40 patients with early gastric cancer by using two different laparoscopic procedures since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 25) and laparoscopic intragastric mucosal resection (n = 15). The indication is as follows; 1) mucosal cancer, 2) < 25 mm, if the lesion is protruded type, 3) < 15 mm and U1 (-), if the lesion is depressive type. All patients were discharged within 4-8 days uneventfully. The resected specimens were 66 +/- 16 mm and 48 +/- 8 mm in diameter respectively, and had a sufficient surgical margin horizontally (16 +/- 5 mm, 8 +/- 4 mm) and vertically. Histology revealed they were all curative surgeries except one case in whom an additional gastrectomy with lymph node dissection by laparotomy was required one month after surgery because lymphatic invasion had been revealed by pathology. In conclusion, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.

Serial growth of human malignant fibrous histiocytoma xenografts in immunodeficient mice

Malignant fibrous histiocytoma (MFH) is on of the most common soft tissue sarcomas of adulthood, the only treatment for which involves surgical resection of the extremities and retroperitoneum, while no standard postoperative adjuvant chemotherapy has been established. We report herein on the establishment of a serially transplantable MFH strain in immunodeficient mice. An intraperitoneal tumor was resected from a patient with multiple recurrent MFH, inoculated into the subcutaneous tissue of mice with severe combined immunodeficiency (SCID), and established as a serially transplantable MFH strain, MH-1. The chemosensitivity of MH-1 was similar to that of the original fresh surgical specimen, as confirmed by the 3-(4,5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT) test. We believe that this serially transplantable strain will be useful for further studies on chemotherapy effective against MFH.