[Modified surgery for early gastric cancer]

Based on the sufficiently accumulated results of early gastric cancer (EGC), particularly the diagnostic accuracy regarding the depth of cancerous involvement in the gastric wall, lymph node metastasis, pattern of recurrence etc., the modified surgery has been induced for the treatment of EGC since late 1970's. The modification is as follows depending on the depth and location of EGC: constriction of size of gastric resection; narrowing of the extent of lymphadenectomy; preserving omentum, pancreas, spleen, pylorus, vagal nerve, lower esophageal sphincter etc; sparing thoracotomy. This kind of surgery has resulted in remarkable reduction of blood loss during surgery, reduced operation time and hospital stay, which have brought improved QOL to the patients as well as satisfactory survival rate after surgery.

Successful treatment of Wolff-Parkinson-White syndrome with concomitant mitral stenosis by simultaneous surgery

We report the case of a 61-year-old man with type B Wolff-Parkinson-White (WPW) syndrome associated with a right atrioventricular (AV) accessory pathway and concomitant mitral stenosis, who underwent successful operative treatment by simultaneous surgery. His preoperative course had been characterized by cardiac failure and repeated episodes of atrial tachyarrhythmia, in the form of fibrillation and flutter, which were difficult to control by conventional medication. Preoperative electrocardiograms (ECGs) had suggested that the accessory pathway was located in the right posterior to posteroseptal wall; however, at the time of surgery, epicardial electrophysiological mapping with sock electrodes revealed a preexcitation area in the AV groove at the lateral right margin of the heart. This discrepancy was thought to have been due to the presence of mitral stenosis or multiple accessory pathways. Thus, division and cryoablation of the accessory pathway by an endocardial approach, in addition to mitral valve replacement, were performed under cardiopulmonary bypass. His postoperative course was uneventful, and subsequent ECGs revealed that the delta waves had disappeared. The successful outcome of this patient demonstrates the effectiveness of simultaneous surgery for WPW syndrome associated with valvular disease.

Antitumour activity of cis-diamminedichloroplatinum (II) against human tumour xenografts depends on its area under the curve in nude mice

A pharmacodynamic analysis of cis-diamminedichloroplatinum(II) (DDP) was conducted using two human gastric cancer xenografts, SC-1-NU and MKN-45, and one human breast cancer xenograft, MX-1, grown serially in BALB/c nu/nu mice. DDP was administered intraperitoneally (i.p.) at a total dose of 5, 10, or 20 mg/kg in a schedule of q7d x 3 or (qd x 5) x 3. DDP was also administered i.p. to BALB/c +/? mice, whose plasma was used for the assay of total and free platinum by the atomic absorption method. A total dose of 20 mg/kg DDP seemed to be the maximum tolerated dose that was effective on MX-1 and SC-1-NU. When the totally administered doses were equivalent, the antitumor effects of the q7d x 3 and (qd x 5) x 3 schedules were similar to each other. The antitumor activity of DDP against MKN-45 was dependent on the total administered dose as well as the area under the curve of free and total platinum in the plasma. Side effects were significantly reduced using a schedule of (qd x 5) x 3 in terms of body and spleen weight loss when a total of 10 or 20 mg of DDP per kg was administered. These results suggest that DDP would be useful when administered using a daily schedule for obtaining the same antitumor activity as that of bolus injection but with reduced adverse effects.

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors

We herein report the usefulness of ultrasound-guided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and "other" in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the postoperative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.

Immediate tonsillectomy for peritonsillar abscess

The usual treatment for peritonsillar abscess (PTAs) in Japan is antibiotic therapy, drainage and incision followed by tonsillectomy several weeks later. This is a retrospective study of cases treated by immediate tonsillectomy (IT) for PTAs between January 1990 and February 1995 in our hospital. There were 119 cases, 94 male and 25 female, ranging in age from 14 to 76 years (average: 36.6). In all cases, we performed CT scan, which is the most reliable diagnostic method for PTAs. Five of the 119 cases were treated by IT under general anesthesia. All five were male and their ages ranged from 50 to 62 years (average: 56.2). Two patients had diabetes mellitus. Bacteriological study revealed alpha-Streptcoccus in 1 case, but the others showed no remarkable findings. Anaerobacteria were not found in any patient. IT under general anesthesia is preferable for advanced PTAs.

Aerosol transport and deposition in the rhythmically expanding pulmonary acinus

Little is known about factors controlling the dynamics of aerosol dispersion and deposition in the lung periphery, though this knowledge becomes increasingly important in many fields such as environmental and occupational exposure, diagnostic applications, and therapeutic deliver of drugs via aerosols. For the last several years, we have been studying aerosol behavior in the pulmonary acinus, where the airway structure and the associated fluid mechanics are distinctly different from those in the conducting airways. Our major research efforts have been focused on the basic physics underlying acinar fluid mechanics and particle dynamics, which are likely to be conditioned by the two key geometric factors of acinar airways: structural alveolation and rhythmic expansion and contraction of the alveolar walls. A combination of computational and experimental analyses revealed that due to these unique geometric features acinar flow can be extremely complex despite the low Reynolds number, and can have substantial effects on particle dynamics. In particular, chaotic mixing can occur in the lung periphery. In the course of such a mixing process, the inhaled aerosol particles quickly mix with the residual alveolar gas in a manner that is radically different from the previously considered classical diffusion process. The objective of this paper is to briefly review our current understanding of these processes, to discuss existing deposition models, and to describe our ongoing research efforts toward a basic understanding of aerosol behavior in the pulmonary acinus.

Influence of chronic liver damage on regeneration of the organ in rats

To investigate the influence of chronic hepatic damage on liver regeneration, a 70% hepatectomy was carried out in male BDE rats in which chronic hepatic damage had been induced by i.m. injection of 0.1 ml CCl4/100 g b. w. twice a week for 4 weeks. After resection, we examined adenine nucleotide concentration in the remaining liver tissues, also body weight and wet and dry weight of the liver. The total adenine nucleotide concentration fell 6 h after resection from 2.89 +/- 0.22 mumol/g to 2.03 +/- 0.15 mumol/g and then recovered on the 3rd postoperative day. However, control animals showed lowest values 3 h after resection, and had already begun to recover at 6 h. Energy charges fell 3 h after liver both groups to the lowest values, but recovery was slower in the animals with chronic liver damage. These observations suggest that in animals with hepatic damage regeneration is delayed in the initial post-resection period. However, 5 days after resection the wet and dry weights of the liver were completely normalized and there was no difference between the two groups, i.e., 5 days after 70% liver resection we could not find any delayed regeneration tendency in animals with chronic liver damage.

Antitumor activity of cis-diamminedichloroplatinum (II) depends on its time x concentration product against human gastric cancer cell lines in vitro

A pharmacodynamic study of cisplatin (DDP) was conducted using the gastric cancer cell lines MKN-45 and MKN-74 in vitro. Ten thousand tumor cells were incubated with 0.4-500 micrograms/ml DDP for 1-25 h, followed by recovery culture for a further 48 h. At the end of incubation, cell viability was detected by the MTT end-point, and the inhibition rate was compared in relation to the incubation time, DDP concentration, and the time X concentration product (area under the curve in vitro: AUC vitro). In both of the cell lines, the IC50 and IC90 values decreased as the exposure time increased, going a linear curve with a slope of almost -1, and showing a typical log-log AUC vitro-dependent curve. These results indicate that the antitumor activity of DDP is dependent on its AUC vitro, suggesting the clinical usefulness of this drug when administered daily in small divided doses.

Intratracheal stent intubation under extracorporeal lung assist

An artificial stent was intubated using extracorporeal lung assist (ECLA) in two patients with inoperable tracheal stenosis. In a patient with an endotracheal tumor, an airway obstruction due to a partial stent collapse was overcome by an immediate ECLA perfusion. In another patient with chronic inflammatory tracheal stenosis, a repetitive balloon dilation of the trachea could be safely performed utilizing ECLA perfusion. Preventive femoral cannulation, employing the assistance of an ECLA circuit, is thus considered to be a safe and effective procedure for the treatment of inoperable tracheal stenosis.

[Surgical treatment of metastatic lung tumor from colorectal cancer]

We have experienced thirty-one operations of metastatic lung tumors from colorectal cancer. Various factors affecting prognosis are studied based on 5-year survival in this report. Overall 5-year survival rate was 32%. Statistical significance was present in the relationship between the prognosis and both maximum diameter of lesions and the disease free intervals (DFI) after surgery for metastatic lesions. Though not significant, sex, stage of primary lesion, nodal involvement, surgical procedure, postoperative serum CEA were likely affecting factors on the prognosis. In contrast, there were no relationship between the prognosis and following factors: age, location of the metastatic lesion, DFI after the operation for primary lesion and chemotherapy. Although pulmonary metastasis is essentially an index of the advanced state of malignant diseases leading to poor prognosis, long-term survivors were encountered in our series of surgical treatments for pulmonary metastases from colorectal cancers. It was concluded to be important to make efforts to extend the indication for surgical treatment, since the appropriate selection of patients revealed to give excellent results from our experience of colorectal cancer. In order to improve the prognosis, early detection of pulmonary metastases is quite important, since the incidence of nodal involvement proved to be higher in lesions with larger diameter resulting in inferior survivals from the present study. In addition, low incidence of nodal involvement in small-sized lesion may support possible applicability of thoracoscopic surgery in the excision of metastatic tumors locating at peripheral lesion.

Extracorporeal membrane oxygenation for respiratory failure

We report herein our experience with extracorporeal membrane oxygenation (ECMO) for respiratory failure over a 3-year period. ECMO was employed in seven patients: in five for respiratory failure caused by adult respiratory distress syndrome (ARDS), Goodpasture's syndrome, hypoxia after ventricular septal defect closure, interstitial pneumonia, or lung metastasis from choriocarcinoma; and in two for tracheal obstruction. Nafamostat mesilate was used as the main anticoagulant with a small amount of heparin. The period of ECMO support for the five patients with respiratory failure ranged from 54 to 251 h, with an average time of 125 h. Five of the seven patients were able to be weaned from ECMO, and the two who had tracheal obstruction survived. The other three patients who were weaned from ECMO died of underlying diseases or complications 1-25 days after weaning. The complications which occurred during ECMO support were an abnormal electroencephalogram, multiple organ failure, and mediastinitis. Thus, we conclude that ECMO needs to be induced early to obtain a better outcome in patients with respiratory failure, and that it is particularly effective for transient airway obstruction.

Gastric microcirculatory disturbance and behaviour of leucocytes after thermal injury: intravital observation of arteriovenous shunting channels in the gastric submucosal layer

In order to investigate the pathogenesis of acute gastric mucosal lesion after thermal injury, microcirculatory disturbance was assessed and observation of the behaviour of leucocytes was performed. Gastric blood flow decreased at 15 min post-thermal injury, and partially improved at 2 h; however, it decreased again at 5 h post-thermal injury. Mucosal microcirculatory disturbance was observed by using vascular labelling with monastral blue B. Deposits of monastral blue B were observed centring mainly on collecting venules but were also observed in the capillaries. Submucosal microcirculatory disturbance was observed through an intravital microscope. The irregularity of the wall and segmental constriction in the venules and presence of an arteriovenous shunting channel was observed in the submucosal layer at 5 h post-thermal injury. The percentage of rolling or sticking leucocytes that passed the confluence of a prevenule and a venule were significantly increased at 5 h after thermal injury. The present study revealed depression of gastric blood flow, mucosal and submucosal microcirculatory disturbance, and a significant increase of rolling and sticking leucocytes in the peripheral part of venules after thermal injury. Leucocyte-endothelial interactions may occur under such conditions and this interaction may play an important role in inducing the microcirculatory disturbance that results in an acute gastric mucosal lesion after thermal injury. The present study also demonstrated the possibility of intravital study of gastric submucosal arteriovenous shunting channels.

Active oxygen species in formation of acute gastric mucosal lesions induced by thermal injury in rats

Active oxygen species generated by circulating leukocytes and released from the gastric mucosa were measured in the process of acute gastric mucosal lesion formation after thermal injury in rats. Alterations of luminol-dependent chemiluminescence activities generated by leukocytes obtained from the gastric vein and the inferior vena cava were approximately same. A decrease in chemiluminescence activity 15 min after thermal injury and a significant increase in chemiluminescence activity 5 hr after thermal injury were observed in leukocytes from both veins. From 15 min to 12 hr after thermal injury, luciferin-dependent chemiluminescence activities were significantly higher than that of the control group. Oral administration of rebamipide resulted in decreased mucosal lesion formation. Rebamipide, an antiulcer agent that protects the mucosa from damage in various animal models decreased chemiluminescence activities only released from the gastric mucosa but not from circulating leukocytes. These results suggest that two different pathways of active oxygen species formation may exist in the pathogenesis of acute gastric mucosal lesions after thermal injury.

Successful surgical management of emphysematous giant bullae accompanied by severe bronchial asthma: report of a case

The surgical treatment of emphysematous lung bullae is usually contraindicated in patients with severe bronchial asthma. However, we recently encountered a patient who required surgery due to the development of respiratory distress despite treatment with bronchodilators and low-dose prednisolone (5 mg/day). During the first operation, bronchospasm occurred with anesthesia. After suppression of the asthmatic symptoms for 2 weeks with high-dose prednisolone (25 mg/day), the giant bullae could be resected safely. Thus, the preoperative resolution of asthma to decrease the probability of an attack is indispensable for such patients.

Inhibitory effects of intravenous lansoprazole on gastric acid hypersecretion in patients with postoperative stress

The inhibitory effects of intravenous lansoprazole on gastric acid hypersecretion caused by stress after surgical invasion were studied in patients who underwent surgery under general anesthesia for gastrointestinal diseases. Patients in this study received either 15 mg or 30 mg of lansoprazole by slow intravenous injection twice daily for 3 days (six injections). The total number of patients studied was 82, with 41 patients in each group. Intragastric pH was measured every 8 h after the start of administration, and the inhibitory effects of intravenous lansoprazole on postoperative gastric acid secretion were evaluated using four grades: excellent, good, fair, and poor. In the 15-mg group, 65.8% (25 of 38 patients) were classified as good or excellent, and in the 30-mg group, 75.7% (28 of 37 patients) were good or excellent. No adverse effects directly attributable to the administration of lansoprazole were observed.

[Effect of prophylactic intra-arterial infusion of anticancer drugs on post hepatic resection for hepatic metastasis of colorectal cancer]

Prophylactic intra-arterial infusion of anticancer drug on post hepatic resection for hepatic metastasis of colorectal carcinoma were performed 8 cases. In our cases consisted of 8 patients of mean age of 54.3 years (male 3 cases and female 5 cases, synchronous metastasis 4 cases and metachronous 4 cases). All patients were received intra-arterial bolus injection of MMC (4-8 mg/body) at day 1 and continuous infusion of 5-FU (250-750 mg/body) for 7 days on admission. After discharged, patients were received bolus injection of 5-FU (250-750 mg/body) for once a week. Side effect of this treatment was not appeared and all of them obtained very good QOL. There were no recurrence sign of residual liver and this procedure was very useful method for post hepatic resection for hepatic metastasis of colorectal cancer.

[Surgical treatment of needles in intracardiac cavity and chest wall--a case report and the review of cases removed under open-heart surgery in Japan]

A 36-year-old woman under the treatment for neurosis stuck five sewing needles into her left anterior chest wall for the purpose of suicide. She was hospitalized with complaints of anterior chest pain and low-grade fever. Chest roentgenogram and computed tomogram showed two needles in the cardiac cavity and three needles in the chest wall. Following extraction of three needles in the chest wall, we removed two needles from the left and the right ventricular cavities under extracorporeal circulation. Preoperative and intraoperative two-dimensional echocardiography was useful for confirming the location of needles.

Gene expression of interstitial collagenase (matrix metalloproteinase 1) in gastrointestinal tract cancers

Collagenolytic proteinases play an important pathological role in the invasion and metastasis of cancer cells. However, little is known about the role of interstitial collagenase (matrix metalloproteinase-1; MMP-1) in this process. To investigate the expression of the MMP-1 gene in cancer tissues, an in situ hybridization study was carried out in gastrointestinal tract cancers (one esophageal cancer, five gastric cancers, and four colorectal cancers), using a 35S-labeled MMP-1 cDNA probe. The MMP-1 gene was expressed in the stromal cells of fibrous tissue around cancer nests, especially at the margin of invasion and/or within the cancer nest; however, no definite expression within cancer cells was observed. Expression of the MMP-1 gene in the stromal cells was more common in well differentiated gastric adenocarcinoma than in poorly differentiated adenocarcinomas. These findings indicate that expression of the MMP-1 gene is greater in stromal cells that are closely associated with cancer cells, suggesting a pathophysiological role of MMP-1 in the invasion and metastasis of cancer cells.

Postnatal reference growth curves for very low birth weight infants

To construct standard growth curves for Japanese infants of very low birth weight (VLBW) with birth weights of 500-1499 g, we reviewed longitudinal data provided by 54 neonatal intensive care units in Japan. A total of 382 surviving singleton infants, appropriate for gestational age infants, and who were free of neurological sequelae at more than 2.5 years of age, were enrolled. Growth curves, including body weight, head circumference and body length were generated for four ranges of birth weight: 500-749 g, 750-999 g, 1000-1249 g, and 1250-1499 g. When compared with previously published growth data from western countries, Japanese infants of VLBW showed greater weight loss, regained birth weight more slowly, and exhibited smaller average gains in weight, head circumference, and body length. The growth curves reported in western countries may not be useful as reference standards of early postnatal growth in Japan. The new growth curves are a more accurate reflection of current in-hospital growth trends in Japan.

[The transverse submammary skin incision for median sternotomy]

Median sternotomy is the incision of choice to allow access to the anterior mediastinum, heart or both lungs. The vertical skin incision is cosmetically unsatisfactory for many female patients. The transverse submammary skin incision with dissection of a flap including the subcutaneous tissue and breasts allow exposure of the sternum for a median sternotomy. Seventy patients with the transverse submammary skin incision was compared with 56 patients with the vertical skin incision in the point of the cosmetic aspect and satisfaction of patients. The transverse submammary skin incision needed a longer wound size and took a longer time for cardiopulmonary bypass, but there were no difficulties in cannulating the ascending aorta for cardiopulmonary bypass. The exposure of the mediastinum and the cosmetic result were excellent. The complications associated with this incision are insignificant if close attention is paid to details.

Frequency and operative correction of aortic insufficiency associated with ventricular septal defect

Frequency and surgical results of aortic cusp prolapse and aortic regurgitation (AR) associated with ventricular septal defect (VSD) were studied. One hundred thirty-six consecutive patients with type I and II VSD according to Kirklin and associates' classification were divided into two groups; group A included 50 patients with type Ia VSD without the conal muscular rim, and group B included 86 patients with type Ib VSD with the conal muscular rim, or with type II VSD. Aortic cusp prolapse was detected in 74% of group A patients and 29% of group B patients. The aortic cusp prolapse correlated negatively with preoperative left-to-right shunt ratio, mean pulmonary artery pressure, and pulmonary-to-systemic pressure ratio in both groups. In group B patients, the smaller the VSD, the higher the frequency of aortic cusp prolapse, especially when less than 4 mm. Aortic regurgitation was observed in 44% of group A patients and 24% of group B patients. All 20 patients with first grade AR underwent VSD closure, 11 with second or third grade AR underwent VSD closure plus valvuloplasty, and 1 with third grade AR underwent aortic valve replacement. Postoperative persistent AR occurred in 8 out of 32 patients, and correlated positively (p < 0.01) with the preoperative grade of AR and the number of plication stitches in both groups.

[Surgical repair of an extreme type of tetralogy of Fallot using valved extracardiac conduit]

Three patients with an extreme type of tetralogy of Fallot underwent corrective surgery using the valved extracardiac conduit for reconstruction of the main pulmonary arteries. The conduit consisted of bicuspid valve which was made of heterogeneous pericardium of 18 or 20 mm in diameter. The conduit was sutured to the pulmonary artery followed by an end-to-end anastomosis between the conduit and a Dacron tube which was sutured to the right ventricular outflow tract. Postoperative echocardiography showed little pulmonary regurgitation. Postoperative courses of all the patients have been uneventful.

2 cases of gastric-cancer remarkably reduced with a combined dosage of irsogladine maleate preparation and uft

Irsogladine Maleate intensifies the degree of intercellular contact so we expected that a combination of Irsogladine Maleate and UFT would cause tumor-reducing effect and normalization of the malignant cells. A combination of Irsogladine Maleate and UFT was administered to 2 patients with inoperable gastric cancer (Case 1: An 83-year-old male: Borrmann type I, Case 2: A 93-year-old female: A relatively wide early gastric cancer), marked tumor reduction was obtained in both cases. The doses administered were 4 mg/day of Irsogladine Maleate and 200 mg/day of UFT.

[Mitral valve replacement in a patient with hereditary hemorrhagic telangiectasia]

A 46-year-old female with mitral insufficiency complicated by hereditary hemorrhagic telangiectasia (Osler's disease) underwent successfully mitral valve replacement. The patient had a history of repeated large-volume nasal bleeding. Mitral valve replacement using a xenograft was safely performed with various attempts for preventing abnormal postoperative hemorrhage.

[Extracorporeal shock wave lithotripsy for choledocholithiasis]

By the advent of extracorporeal shock wave lithotripsy (ESWL), the plan to manage choledocholithiasis has changed greatly. As a non-operative treatment, endoscopic sphincterotomy (EST) is intensively performed, but ESWL is much safer than EST in invasiveness and complications. Without EST, 5 Fr endoscopic naso-biliary drainage (ENBD) and percutaneous transhepatic biliary drainage (PTBD) aiming at preservation of the function of the papilla Vater were inserted to make drainage first for the patients with choledocholithiasis with obstructive jaundice who visited our hospital. After the cholangitis subsided, ESWL was performed under the direct cholangiography through ENBD and PTBD and excellent results were obtained which are herein reported. ENBD has been performed on 98 cases of choledocholithiasis over the past 4 years. ESWL has been performed on 42 cases (ENBD 36 cases and PTBD 6 cases). Choledocholithiasis completely disappeared in 31 cases (73.8%). For unsuccessful cases, EST, percutaneous transhepatic cholangioscopy (PTCS), or laparotomy was performed.

[Surgical treatments of emphysematous giant bullae accompanied with severe bronchial asthma]

Two operative cases of emphysematous giant bullae of the lung accompanied with bronchial asthma were reported. Case 1: A 41-year-old man suffering from dyspnea and fever-up was diagnosed as emphysematous giant bullae of the right lung accompanied with severe bronchial asthma. Preoperative examination revealed severe hypoxemia (PO2 46 mmHg) and mixed type ventilatory disorder; VC 1.68 t (41%), FEV1.0 0.59 l (35%). On the first anesthesia, operation was postponed by the severe asthmatic attack and circulatory collapse. After the complete prevention of the attack by giving corticosteroid (25 mg/day) for two weeks, resection of giant bullae could be performed safely. Case 2: A 31-year-old man complaining wheeze was diagnosed as emphysematous giant bullae of bilateral upper lobes of lung accompanied with bronchial asthma. Preoperative and intraoperative states were uneventful, though, on the day after the operation, asthmatic attack occurred due to the difficulty in expectation of sputa. It took 12 hours and many kinds of drugs to improve the respiratory state. In the patients of bronchial asthma, preoperative sufficient suppression of hyperreactivity of airway tracts and postoperative careful treatment to avoid asthmatic attack seem to be indispensable.

[Clinical evaluation of operative and non-operative treatment in hepatocellular carcinoma with main portal vein tumor thrombus]

It has been well recognized that results of treatment in hepatocellular carcinoma with main portal vein tumor thrombus (Vp 3 HCC) are very poor. But we tried aggressive transcatheter treatment (one shot or continuous hepatic arterial infusion, TAE) and hepatectomy with postoperative TAE in 52 cases by Vp3 HCC in recent 10 years. Analysis of the results disclosed that PR or CR cases were observed only in the series of continuous hepatic arterial infusion therapy. And cumulative survival rate was the best in the series of hepatectomy (50% survival interval is 18 months). We concluded that hepatectomy and resection of the tumor thrombus with postoperative TAE is the best treatment in Vp3 HCC.

Complete disappearance of metastatic abdominal tumors from gastric cancer after treatment with irsogladine maleate

A 60-year-old woman with gastric cancer had undergone partial gastrectomy in September 1989. Pathological examination revealed a poorly differentiated adenocarcinoma of pT3pN3pM0 (not resected for cure), stage IV. Postoperative adjuvant therapy comprised 1-(tetrahydro-2-furanyl)-5-fluorouracil plus uracil and OK-432. On 11 August 1990, two forefinger-tip-sized tumors were palpated beneath the operation scar. They increase in size, the superior tumor reaching 4x3 cm, the inferior tumor 5x3 cm on 5 September. Then, on 17 September, the inferior tumor was resected but the superior tumor remained; the histological type was poorly differentiated adenocarcinoma. After the operation, from 20 September, she was given 4 mg irsogladine maleate orally every day. On 8 October, there was no increase in the size of the superior tumor. By 29 October, the superior tumor had disappeared and no further tumor appeared thereafter; the patient showed no sign of relapse.

The collagenase activities, interstitial collagenase and type IV collagenase, in human stomach cancer: with special reference to local spreading and lymph node metastasis

In order to investigate the role of collagenase in cancer invasion and metastasis, two collagenase activities of interstitial collagenase and type IV collagen degrading enzyme (type IV collagenase) were determined in 40 cases of human stomach cancer tissue. Elevated cancers which are known to have a propensity to cause blood-borne metastases showed higher activities of both interstitial collagenase and type IV collagenase than flat or ulcerous type of cancer. Using the parameters of lymph node metastasis vs tumor size or vs depth of cancerous invasion into the stomach wall, classification of the cases was attempted according to the degree of malignancy. In the cases with marked lymph node metastases in spite of small tumor size and/or shallow cancerous invasion into the stomach wall, type IV collagenase activity was higher than that in the cases with lower malignancy (p less than 0.025, p less than 0.05, respectively). These results suggest that collagenase in stomach cancer tissue play an important role in the invasion and metastasis of cancer cells. Type IV collagenase activity in stomach cancer tissue could be one of the useful biological markers for the degree of malignancy.

Cycloheximide induces stromelysin mRNA in cultured human fibroblasts

Stromelysin is a metalloproteinase that degrades extracellular matrix macromolecules including fibronectin, laminin, collagen IV and proteoglycans. We now report that cycloheximide, an inhibitor of protein synthesis, induces human stromelysin mRNA in fibroblast cultures in a time- and dose-dependent fashion. As determined by Northern hybridization, a 24-h treatment with cycloheximide increased stromelysin mRNA about 20-fold over the control level. In vitro translation or translation in cells after removal of cycloheximide resulted in increased levels of immunoprecipitable stromelysin suggesting that the cycloheximide-induced stromelysin mRNA was functional. Analysis of mRNA stability suggested that the cycloheximide effect is in part due to the increased activation of the stromelysin gene. In contrast to these results, cycloheximide did not induce collagenase mRNA but, rather, prevented its induction by interleukin-1 beta. These data provide evidence for discoordinate regulation of collagenase and stromelysin genes and suggest that a short-lived repressor protein may play a role in the stromelysin gene expression.

[CT of abdominal blunt trauma]

We studied CT findings and Interventional Radiology including therapeutic procedures in 43 cases with abdominal blunt trauma, retrospectively. All of parenchymal organ's injuries, and injuries of duodenum & retroperitoneum were correctly diagnosed by CT. In 14 cases with only hemoperitoneum or no positive findings on CT, 4 cases were jejunal perforations, and remaining 10 cases were conservatively treated and relieved. We have to take care that the similar CT findings include the opposite results to need surgery and not.

Nitrate reduction in root and shoot and exchange of reduced nitrogen between organs in two-row barley seedlings under light-dark cycles

Nitrate reduction in roots and shoots and exchange of reduced N between organs were quantitatively estimated in intact 13-d-old seedlings of two-row barley (Hordeum vulgare L. cv. Daisengold) using the (15)N-incorporation model (A. Gojon et al. (1986) Plant Physiol. 82, 254-260), except that NH + (4) was replaced by NO - (2) . N-depleted seedlings were exposed to media containing both nitrate (1.8 mM) and nitrite (0.2 mM) under a light-dark cycle of 12:12 h at 20°C; the media contained different amounts of (15)N labeling. Experiments were started either immediately after the beginning (expt. 1) or immediately prior to the end (expt. 2) of the light period, and plants were sampled subsequently at each light-dark transition throughout 36 h. The plants effectively utilized (15)NO - (3) and accumulated it as reduced (15)N, predominantly in the shoots. Accumulation of reduced (15)N in both experiments was nearly the same at the end of the experiment but the accumulation pattern in roots and shoots during each 12-h period differed greatly depending on time and the light conditions. In expt. 1, the roots accounted for 31% (light), 58% (dark), and 9% (light) of nitrate reduction by the whole plants, while in expt. 2 the contributions of the root were 82% (dark), 20% (light), and 29% (dark), during each of the three 12-h periods. Xylem transport of nitrate drastically decreased in the dark, but that of reduced N rather increased. The downward translocation of reduced (15)N increased while nitrate reduction in the root decreased, whereas upward translocation decreased while nitrate reduction in the shoot increased. We conclude that the cycling of reduced N through the plant is important for N feeding of each organ, and that the transport system of reduced N by way of xylem and phloem, as well as nitrate reduction by root and shoot, can be modulated in response to the relative magnitude of reduced-N demands by the root and shoot, with the one or the other predominating under different circumstances.

Transcriptional regulation of human stromelysin

We have determined that human stromelysin mRNA can be induced by interleukin-1 beta (IL-1 beta) and that the induced mRNA levels can be suppressed by retinoic acid and dexamethasone (Saus, J., Quinones, S., Otani, Y., Nagase, H., Harris, E.D., Jr., and Kurkinen, M. (1988) J. Biol. Chem. 263, 6742-6745). Here we show, by nuclear run-on and transient gene expression analyses, that IL-1 beta induction is a promoter function and that dexamethasone suppresses IL-1 beta-induced gene activity. For transient gene expression assays, 1.3 kilobase pairs of the stromelysin promoter region (-1303 to -11 relative to the transcription start site) and shorter fragments thereof were cloned into a human growth hormone reporter vector. In transfected human fibroblast cultures all the constructs, with the exception of the one containing the shortest promoter fragment (-53 to -11), responded to IL-1 beta induction. Interestingly, the ability of IL-1 beta to induce human growth hormone expression decreased as the length of the promoter fragment was reduced. Dexamethasone treatment suppressed the induced human growth hormone levels by approximately 50% irrespective of the promoter length. These results suggest that the 1.3-kilobase pairs stromelysin promoter fragment contains DNA elements required for IL-1 beta induction and dexamethasone suppression.

Significance of thymus differential ratio in immunologic status of graft tolerance

LEW with BDE-heart graft received 0 (control), 15, or 40 mg cyclosporine (CsA)/kg b. wt. per day. On postoperative days 3, 5, 7, 10, and 14 in four animals each weight and cell count of thymus and spleen were determined, and thymus and spleen cell subpopulations were examined with monoclonal antibodies. The same tests were performed in FiS heart graft recipients without immunosuppression and ungrafted LEW which received 15 or 40 mg CsA. We expressed alterations in thymocyte subpopulations by using the differentiation ratio (DR), i.e., differentiated in % of all T-cells and by the ratio of helper to suppressor/cytotoxic T-cells (Th-Ts/c). In graft rejection the thymus showed no significant change in DR or Th-Ts/c. However, in the CsA-induced graft tolerance DR was elevated and at the same time Th-Ts/c declined, both showing maximum values on days 5 and 7 and a return to normal thereafter. FiS graft recipients exhibited similar thymus alterations as tolerant recipients, but less marked. In CsA-treated ungrafted LEW, elevation of DR was slight after 15 mg but very strong after 40 mg CsA (93% on day 7), and it did not return to normal in the latter group. Th-Ts/c was decreased in these ungrafted animals, but not as strongly as in tolerant graft recipients. Such thymus alterations were not observed in graft rejection. Spleen weights were strongly increased in graft rejection and unchanged in graft tolerance. Splenic Ts/c and Th-Ts/s were increased in CsA-treated tolerant recipients but not in graft rejection. We conclude that elevation of DR and decline of thymic Th-Ts/c in the initial postoperative phase are indicators of graft tolerance in organ recipients.

The complete primary structure of human matrix metalloproteinase-3. Identity with stromelysin

We have determined the complete primary structure for human matrix metalloproteinase-3 (MMP-3), which has 477 residues including a 17-residue signal peptide. The result indicates that MMP-3 is identical with stromelysin (Whitham, S. E., Murphy, G., Angel, P., Rahmsdorf, H.-J., Smith, B. J., Lyons, A., Harris, T. J. R., Reynolds, J. J., Herrlich, P., and Docherty, A. J. P. (1986) Biochem. J. 240, 913-916). A striking result is that MMP-3 and collagenase are 54% identical in sequence, suggesting a common origin for the evolution of the two proteinases. We also show that in human synovial fibroblast cultures human recombinant interleukin-1 beta rapidly induces high levels of MMP-3 mRNA and, conversely, that retinoic acid or dexamethasone can suppress the MMP-3 mRNA levels. Similar results were obtained for human synovial collagenase mRNA. The data suggest that MMP-3 and collagenase expression are coordinately modulated in synovial fibroblast cultures.

Thymus alteration in hepatic regeneration

We performed 70% hepatectomy in LEW rats and examined immunologic alterations during hepatic regeneration; especially, thymus weight and cell count, T-cell subpopulations, differentiation ratio of thymocytes (DR) and ratio of T-helper to T-suppressor/cytotoxic cells (Th-Tsc). Strongest liver regeneration was observed on postoperative days 2-5 and it was completed on day 7. During hepatic regeneration a significant thymus atrophy in weight and cell count was found on day 3 and 5, it normalized from the 7th day on. T-cells were highly differentiated during liver regeneration with a DR of 35.7 +/- 2.5%, 64.0 +/- 4.4% and 38.8 +/- 3.0% on postoperative days 3, 5, and 7, respectively, and at the same time Th-Tsc ratio was reduced to 0.57 +/- 0.11, 0.38 +/- 0.04 and 0.57 +/- 0.05, respectively. DR and Th-Tsc ratio showed a trend to normalization from the 7th day on. No changes of thymus and T-cell subpopulations occurred in a sham-operated control group. Since we found such thymus alterations also in spontaneous or drug induced tolerant graft recipients, we conclude that the hepatic regenerative potential possesses a suppressive effect on immune responses.

Alteration of thymus and of immune regulatory-antifibroblast factors in acute and chronic hepatic damage

We studied in this paper the behavior of immunosuppressive and fibroblast proliferation inhibitory factors in the acute, chronic damage and cirrhotic alteration of the liver. We induced in LEW-rats acute hepatic necrosis by i.v. application of dimethylnitrosamine (DMNA: 35 mg/kg b.wt.) and by i.m. injection of CCl4 (1 ml/kg b.wt., twice a week). After 2-4 weeks we found chronic hepatic damage and after 8-10 weeks liver cirrhosis. As a control, untreated animals were used. Sera and liver factors were prepared from the animals and used for inhibition tests of fibroblast proliferation and MLC reaction. Furthermore, cell count and cell subpopulation of the thymus were determined by monoclonal antibodies (W3/25, OX-8). LF of untreated and DMNA-treated animals exhibited very strong unspecific inhibition effects of fibroblast proliferation and allogenic stimulation. However, with progression of hepatic damage (chronic hepatitis and cirrhosis) both suppressive abilities were gradually reduced. Normal sera showed very slight inhibition of allogenic stimulation but sera of animals with acute hepatic damage showed very strong inhibition. In the 2 weeks of CCl4 treatment, their inhibitory abilities were more than 40%, and with progression of hepatic damage they were gradually reduced. Normal sera or sera of animals with chronic hepatic damage could not suppress the fibroblast proliferation; however, sera of acute hepatic damage inhibited it very strongly. With chronic hepatic damage, the thymus gradually atrophied and, after 10 weeks of CCl4 treatment, it had atrophied completely. Thymocyte differentiation was found only in animals with acute hepatic damage. This suggests that factors which were liberated from the damaged hepatocytes caused differentiation of the thymocytes.

[New operative technic for resecting cardiac cancers with dissection of the lower mediastinal lymph nodes through transabdominal phrenotomy using an improved hook suspender and an autosuture surgical stapling instrument]

To obtain a sufficient operative field at the operation for cardiac cancer, especially with esophageal infiltration, thoracotomy or sternotomy has been added to laparotomy. These procedures are not easy and cause great stress in patients. Through our new technique, left sided thoracotomy and sternotomy can be eliminated in favor of transabdominal phrenotomy, which is able to be performed much easier to obtain a good operative field. In order to perform the phrenotomy, the diaphragm has to be stretched using our modified hook suspender, by which the costal arch is lifted strongly upward and cranially. With these procedures, about a 5cm long esophagus is able to be resected with lymph node dissection in the lower mediastinum without difficulty. No marked influence of the hook suspender as well as the phrenotomy has been recognized on respiratory and circulatory systems. The anastomosis between the esophagus and jejunum or residual stomach seems to be very difficult, because the site of the anastomosis is located quite deep in the mediastinum. This problem, however, can be completely resolved by means of a surgical stapling autosuture instrument.

Molecular cloning and nucleotide sequence of the lipase gene from Pseudomonas fragi

The gene coding for the lipase of Pseudomonas fragi was cloned into Escherichia coli JM83 by inserting Sau3A-generated DNA fragments into the BamH I site of pUC9. The plasmid isolated, pKKO, was restriction mapped and the position of the lipase gene on the 2.0 kb insert was pinpointed by subcloning. DNA sequencing revealed that the open reading frame comprises 405 nucleotides and gives a preprotein of 135 amino acids with a predicted Mr of 14643. By comparing the putative lipase amino acid sequence with porcine pancreatic, rat lingual and Staphylococcus hyicus lipases the amino acid sequence around the reactive serine was found to be common among the types of lipase which have been reported.