[The treatment and clinical issue of gastric cancer with infiltrating the adjacent organs]

We discussed the advances and clinical issue including complications in the treatment of gastric cancer infiltrating the adjacent organs. Recent years, the proportion of the patients with gastric cancer infiltrating the adjacent organs are decreasing, but there isn't remarkable advances in the treatment result of them. That is due to the fact that about one half of them has distant metastasis, such as peritoneal dissemination or liver metastasis. Whatever the survival rate of the patients who was performed combined resection is better than unresected cases. The postoperative complications of the combined resection cases is two times as much as the uncombined resected cases. Therefore we should perform combined radical resection for the patients without distant metastasis, and for the patients with distant metastasis, we should perform palliative surgery for the purpose of improving QOL.

Development of resistance to Microdochium nivale in winter wheat during autumn and decline of the resistance under snow

The effect of autumn climate on the development of resistance to pink snow mold (Microdochium nivale) in winter wheat was estimated in mid-December. Changes in resistance over time under snow cover were also determined. Resistance in December was closely correlated with the accumulated degree-days above 0 °C from sowing. The number of days of incubation at which 50% of the plants are killed (LI50) was lowest in the cool autumn in 1988 and highest in the warm autumn in 1989. Temperatures below 5 °C were also required for expression of resistance. Differences in LI50 between resistant and susceptible cultivars were most apparent in late autumn. Continuous snow cover was found to reduce resistance to pink snow mold. The rate of decline of the resistance in cv. Nanbukomugi during the winters under snow was lower than in cv. PI 173438 and cv. Kitakamikomugi. The resistance to pink snow mold was correlated with the amount of etiolated growth at 25 °C. This indicates that exhaustion of food reserves during prolonged snow cover predisposed wheat plants to snow mold diseases. Key words: pink snow mold, Fusarium nivale, Monographella nivalis, resistance progressive and degressive curves, Triticum aestivum L., field test.

[Left upper abdominal evisceration for advanced gastric cancer]

To evaluate the clinical significance of the surgical procedure of left upper abdominal evisceration (LUAE), we analysed the prognosis of patients who received LUAE in the Cancer Institute Hospital from 1980 to 1990 using pair matching analysis. Survival benefits were observed in the patients with the tumor located in the upper or middle part of the stomach, and especially in those with Borrmann type 4 gastric cancer. Even in cases of peritoneal dissemination, patients who received LUAE survived longer than those with conventional total gastrectomy. These results indicated that LUAE should be a standard surgical approach for Bormann type 4 gastric cancer.

[The accuracy and clinical issue of preoperative diagnosis of gastric cancer]

We discussed the accuracy and clinical issue of preoperative diagnosis for 764 patients with gastric cancer from 1987 to 1990. The accuracy of diagnosis, location, tumor size, wall invasion, involved lymph node were 81.8, 80.5, 62.2, 82.5% respectively. The clinicopathological characteristics of the regions which we missed preoperative diagnosis are infiltrating type and scirrhous type in diagnosis of tumor size, and large tumor in diagnosis of wall invasion. Especially in the case of early gastric cancer, we missed diagnosis of wall invasion of the regions with clinicopathological characteristics as follows: depressed type, undifferentiated type and ulceration in lesions. Now it is difficult to diagnosis wall invasion before surgery, so we have to be careful to determine the indication of endoscopic resection or limited operation for early gastric cancer, especially with clinicopathologic characteristics stated as above.

Evaluation of hepatic proliferative activity in chronic liver diseases and hepatocellular carcinomas by proliferating cell nuclear antigen (PCNA) immunohistochemical staining of methanol-fixed tissues

The proliferative activity of chronic liver diseases and hepatocellular carcinomas (HCCs) was studied by PCNA immunohistochemistry. Human liver tissues were obtained by surgical operation or needle biopsy, and PCNA was detected by immunohistochemistry. PCNA-labelling indices (PCNA-LIs) of methanol-fixed tissues corresponded with the incidence of S-phase cells previously reported, whereas paraformaldehyde-fixed tissues showed extremely high PCNA-LIs in all specimens. Therefore, methanol-fixed tissues were used for evaluation. The PCNA-LIs of the methanol-fixed tissues were: normal liver 0.78 +/- 0.38%, chronic persistent hepatitis 1.06 +/- 0.86%, chronic aggressive hepatitis 2A 1.01 +/- 0.50%, chronic aggressive hepatitis 2B 4.20 +/- 1.79%, inactive cirrhosis 0.81 +/- 0.49%, active cirrhosis 1.96 +/- 0.93%, HCC of Edmondson's type I 4.83 +/- 1.98%, type II 6.65 +/- 1.69%, and type III 38.7 +/- 30.6%. PCNA-positive cells showed little specific distribution; in periportal areas in chronic hepatitis, at the margins of pseudolobules in cirrhosis, and throughout the tumor in HCC. These findings indicated that proliferative activity increased during the progression of chronic hepatitis, but that it decreased at the stage of cirrhosis. In chronic liver diseases, the PCNA-LIs reflected hepatitis activity. HCC showed higher proliferative activity than liver cirrhosis, and the histological grade was correlated with the PCNA-LI.

Lack of synergistic association between human papillomavirus and ras gene point mutation in laryngeal carcinomas

The spectrum of human papillomavirus (HPV) subtypes in laryngeal carcinomas was investigated by combined polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. HPV DNA was detected in 11 (24%) of 45 cases, including HPV 16 in 9 cases and HPV 18 in 2 cases. Other HPV subtypes commonly found in the female genital organs were not detected. In addition, the point mutation of codons 12 and 13 in c-Ki-ras-2, c-Ha-ras-1, and N-ras genes was studied by the PCR-single-strand conformational polymorphism (SSCP) method. Of 45 cases tested, only 1 had a point mutation of c-Ki-ras-2 gene at codon 12. These results indicate that the incidence of ras gene point mutation is uncommon and that the synergistic effect of HPV infection and ras gene activation in laryngeal carcinogenesis is probably rare.

Internal jugular bulb blood velocity as a continuous indicator of cerebral blood flow during open heart surgery

BACKGROUND

Most techniques for measuring cerebral blood flow (CBF) can not be performed rapidly enough to detect sudden changes in CBF. However, measurement of internal jugular bulb (IJB) blood velocity may offer real-time information on changes in CBF. In the current study, we measured IJB blood velocity and CBF in anesthetized humans.

METHODS

In protocol 1, IJB blood velocity was continuously measured using an intravascular Doppler catheter during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). CBF values obtained with a Kety-Schmidt method using inhalation of 30% argon in oxygen gas were compared with concurrent IJB blood velocity values in ten patients. A 3-French intravascular Doppler catheter was placed in the right IJB, and CBF measurements were made before CPB, in a stable hypothermic period during CPB, at rewarming during CPB, and after CPB. In protocol 2, dimensions of right IJB were observed before and during CPB using an intravascular rotating A scan ultrasonic catheter (5-French) in three patients.

RESULTS

IJB blood velocity responded quickly to changes in arterial pressure or body temperature during CPB. The percent change in IJB blood velocity relative to pre-CPB value showed a good linear correlation with the percent change in CBF (%CBF = 0.87 x %IJB velocity + 17, r = 0.87). The mean difference between percent changes in CBF and IJB blood velocity was -5.6% and the standard deviation was 16%. Despite a large reduction in arterial pressure or IJB pressure, there were no significant changes in the IJB dimension.

CONCLUSIONS

The results suggest that IJB blood velocity may represent a clinically useful monitor of changes in CBF in anesthetized humans.

[Progress of the treatment of gastric cancer in Cancer Institute Hospital, Tokyo]

From 1946 to 1990, a total of 10,485 cases of gastric cancer patients were treated at the Cancer Institute Hospital (CIH), Tokyo. During the past 46 years, CIH contributed to various aspects of surgical treatment of gastric cancer; extensive radical surgery for advanced cancer, safe reconstruction methods after total gastrectomy, modified surgery for early stage cancer, and multimodality therapy for moderately advanced cancer. Five-year survival rate was 20% for all cases in 1940s, and 66.5% for 1980s. Improvement in the treatment results could be attributed to the relative increase in the number of early stage cancers, the increase in the rate of curative surgery (R0), and incorporation of multi-modality therapy before or after curative surgery. Stage-oriented therapy is mandatory for further improvement in the treatment results and the patient's quality of life after surgery.

[Treatment of recurrent gastric cancer]

The recurrence rate of resected gastric cancer was 31.9%. The rate was in creasingly higher in proportion to the lack of radicality. The most common type of recurrence was peritoneal dissemination, followed by hematogeneous metastasis, local recurrence, and distant lymph node metastasis. The treatments for recurrence were surgery (9.3%) and chemotherapy (16.1%). Systemic chemotherapy (intravenous iv) was common, and local chemotherapy (intraarterial ia, intraperitoneal ip) was rate. The efficacy of systemic chemotherapy (iv) for recurrent gastric cancer without local recurrence was suggested. The efficacy of local chemotherapy (ia) was suggested for peritoneal dissemination and local recurrence.

[The analysis of prognosis of patients with gastric cancer with the nodal stage(N, n) and the number of involved lymph nodes]

Now we use the nodal grade (N, n) as a prognostic indicator in patients with gastric cancer according to the general rules for the gastric cancer study. But there are both of patients with good and poor prognosis in the same nodal grade. Then we analyzed the survival of patients with gastric cancer based on the nodal grade and the number involved lymph nodes, and discussed the new prognostic indicator with both of them. We classified the three groups based on the number of involved nodes as follows: 0.1-4.5-. There is the differences in survival between each pair of groups statistically. The relationship between the nodal grade (N, n) and the number of lymph node metastasis is that the survival of patients with involved nodes more than five is equal to the survival of the patients with high nodal grade and involved nodes 1-4. Therefore it suggest that the new grading consisting of them will be more better prognostic indicator.

Left ventricular diastolic function in patients on maintenance hemodialysis: comparison with hypertensive heart disease and hypertrophic cardiomyopathy

To elucidate the differences in the left ventricular diastolic function between patients on maintenance hemodialysis with left ventricular hypertrophy and the those with left ventricular hypertrophy from other causes, 20 patients on maintenance hemodialysis (HD group; mean age 44 +/- 12 years), 12 patients with hypertensive heart disease (HHD group; mean age 43 +/- 10 years), and 10 patients with hypertrophic cardiomyopathy (HCM group; mean age 43 +/- 11 years) were examined non-invasively using diastolic time intervals and digitized echocardiograms. Ten age-matched healthy men (N group; mean age 43 +/- 12 years) were also examined. Compared with the HCM group, the HD and HHD groups had a decreased total left ventricular wall thickness and left atrial dimension, an increased ratio between the left ventricular enddiastolic dimension and total left ventricular wall thickness. The isovolumic relaxation and rapid relaxation periods were prolonged in the order of HCM, HHD, HD and N, but the active suction period was prolonged only in the HCM group. The peak rate of change in the left ventricular dimension during the rapid filling period was decreased in the HCM group, compared with the HD and the HHD groups. These results indicate that hemodialysis patients with left ventricular hypertrophy have some impairment in left ventricular diastolic function, but the degree of the disturbance is similar to that observed in those with hypertensive heart disease, but milder than that observed in those with hypertrophic cardiomyopathy.

Flow cytometric analysis of primary and metastatic squamous cell carcinomas of the oral and maxillofacial region

OBJECTIVE

To elucidate characteristic changes in nuclear DNA content and cell kinetics in primary lesions and metastatic lymph nodes of squamous cell carcinomas of the oral and maxillofacial region.

MATERIALS AND METHODS

Materials used were paraffin-embedded tissue specimens obtained from 96 primary lesions of 96 patients and 85 metastatic lymph nodes of 41 patients with squamous cell carcinoma of the oral and maxillofacial region. Single cell suspensions for flow cytometry analysis were prepared, and cell cycle analysis was performed.

RESULTS

The incidence of aneuploidy in 41 carcinomas with metastasis was 39%, which was significantly higher than the 16% incidence in 55 carcinomas without metastasis. In terms of T classification and mode of invasion, the incidence of aneuploidy and metastasis increased with the increase in gradings. Forty-four of 46 metastatic lymph nodes associated with 25 diploid primary tumors remained diploid, whereas a shift down to diploidy was observed in 25 of 39 metastatic lymph nodes associated with 16 aneuploid primary tumors. The incidence of aneuploidy and S-phase fractions of 85 metastatic lymph nodes in 41 patients were 19% and 9.6%, respectively. The values were significantly lower than the 39% and 14.3% of the corresponding primary lesions.

CONCLUSIONS

The chance of evolution of metastatic cell lines is higher in aneuploid carcinomas than diploid carcinomas, possibly because the former are more heterogenous; however, most cell lines responsible for causing lymph node metastasis are diploid.

[Prognostic factors of the gastric cancer patients without distant metastasis]

From 1946 to 1990, 10,485 patients with gastric cancer were been surgically treated in the Cancer Institute Hospital, Tokyo. Retrospectively, we analyzed prognostic factors, especially in those without distant metastasis. Prognosis of the patients with tumors which invaded the proper muscle layer improved dramatically (from 70% to 90%). However, patients who had advanced tumors with serosal invasion did not show good survived (from 20% to 40%). To improve the prognosis of patients with serosal positive gastric cancer, a new and effective prophylactic therapy for peritoneal recurrence is needed.

Glory of clouds in the near infrared

Spectrally resolved visible and infrared images of marine stratus clouds were acquired from the NASA ER-2 high-altitude aircraft during the 1987 First International Cloud Climatology Program Regional Experiment. The images were obtained by cross-track scanning radiometers. Data images at nearinfrared wavelengths show frequent and readily apparent brightness features that are due to glory single scattering. The observations and subsequent analysis by radiative transfer calculations show that the glory is a significant feature of near-infrared solar reflectance from water clouds. Glory observations and calculations based on in-cloud microphysics measurements agree well. The most dramatic difference from the visible glory is that the scattering angles are significantly larger in the near infrared. The glory is also apparently more distinct in the near infrared than in the visible, as scattering size parameters are in a range that effectively produces a glory feature, and also there is less obscuration bymultipe-scattering reflectance because of absorption of radiation by droplets in the near infrared. For both the visible and the near infrared, the principal factors that wash out the glory are dispersion and, to a lesser degree, the effective radius of the cloud droplet-size distribution. The obscuration by multiple scattering in optically thick clouds is secondary. Rather than being a novelty, glory observations would be an accurate and unambiguous technique to sense the droplet size of water clouds remotely.

Involvement of cell wall beta-glucan in the action of HM-1 killer toxin

HM-1 killer toxin secreted from Hansenula mrakii inhibits the growth of Saccharomyces cerevisiae cells by interfering with beta-1,3-glucan synthesis. We found that HM-1 killer toxin killed intact cells but not protoplasts. In addition, cells lacking the functional KRE6 allele (kre6 delta) became resistant to higher concentration of HM-1 killer toxin. As reported by Roemer and Bussey [(1991) Proc. Natl. Acad. Sci. 88 11295-11299], cells lacking functional KRE6 had a reduced level of the cell wall beta-1,6-glucan compared to that in cells harboring the normal KRE6. These results suggest that the cell wall beta-glucan is involved in the action of HM-1 killer toxin. Addition of HM-1 killer toxin with several kinds of oligosaccharides revealed that either beta-1,3- or beta-1,6-glucan blocked the cytocidal action of HM-1 killer toxin whereas alpha-1,4-glucan and chitin did not. Mannan also interfered with HM-1 killer toxin action, but this inhibitory effect was much weaker than that observed with beta-1,3- or beta-1,6-glucans. Thus, it appears that the cell wall beta-glucan interacts with HM-1 killer toxin, and that this toxin-beta-glucan commitment is required for the action of HM-1 killer toxin.

Fine antigen specificity of human gamma delta T cell lines (V gamma 9+) established by repetitive stimulation with a serotype (KTH-1) of a gram-positive bacterium, Streptococcus sanguis

We have established human gamma delta T cell lines specific for Streptococcus sanguis (S. sanguis) KTH-1 present in normal oral cavity flora. The CD4-CD8-CD3+V gamma 9+V delta 1-CD45RO+ CD25+ T cell lines showed a proliferative response to the streptococcal antigen (Ag) in the presence of autologous antigen-presenting cells without apparent evidence of HLA restriction. The proliferative response of the gamma delta T cell lines was completely blocked by anti-TcR gamma delta monoclonal antibody (mAb) and anti-HLA class I mAb (W6/32), whereas anti-HLA classical class Ia mAb (B-H9; anti-HLA-A,B,C), anti-HLA class II mAb (anti-DR, anti-DQ, and anti-DP) and anti-CD4 mAb did not have any inhibitory effects. Surprisingly, the gamma delta T cell lines showed the proliferative response against the original bacterial Ag KTH-1 exclusively, and exhibited no cross-reactivity with nominal Ag such as purified protein derivative of tuberculin, tetanus toxoid and Mycobacterium tuberculosis, or the same species but different strain of S. sanguis, American Type Culture Collection (ATCC) standard strain (10556), or even with the same strain but different serotype of S. sanguis, KTH-3. Moreover, cytokine production of the gamma delta T cell lines was similar to the Th1 pattern [interferon-gamma, tumor necrosis factor (TNF)-alpha and TNF-beta]. They also produced interleukin-8 that functions as one of chemoattractants for polymorphonuclear cells. Using direct sequencing technique of the polymerase chain reaction products, we found that junctional diversity of the T cell receptor (TcR) used by the parental KTH-1 specific gamma delta T cell line and its subclones is rather limited. It is suggested that gamma delta T cells with canonical TcR could preferentially respond to KTH-1 Ag. Thus, in addition to a broad or cross-reactivity of gamma delta T cells against phylogenetically conserved stress/heat-shock protein, which is well characterized by others, some peripheral blood gamma delta T cells could recognize and kill exogenous agents with fine antigenic specificity to protect the body against them.

Establishment and characterization of synovial cell clones with integrated human T-cell leukemia virus type-I

Human T cell leukemia virus type-I (HTLV-I)-integrated synovial cell clones (SCCs) were established from four HTLV-I-infected patients with chronic proliferative arthropathy. Extracted DNAs of these SCCs were examined for the existence of HTLV-I proviral DNA. Electron microscopic analysis and immunohistochemical staining were also performed to examine the nature of the HTLV-I integrated SCCs. SCCs derived from all four patients consisted of either HTLV-I integrated or nonintegrated cells. HTLV-I integrated SCCs also produced viral messenger RNA which was detected by reverse transcriptase-polymerase chain reaction as well as viral protein which was detected by immunohistochemical staining. Phenotypically, these SCCs containing HTLV-I proviral DNA were shown to be all cell types as observed by electron microscopic analysis and immunohistochemical analysis. Moreover, expression of HTLV-I glycoprotein was greater in SCCs with a monocyte marker. These findings suggest that SCCs harboring HTLV-I have an important role in synovial hyperplasia.

Characteristic bright signal of parotid pleomorphic adenomas on T2-weighted MR images with pathological correlation

The purpose of this study was to correlate the MR features and histological findings of pleomorphic adenomas, which are the most common tumour of the parotid gland, and to distinguish them from other types of tumour in the parotid gland. The materials studied consisted of 20 pleomorphic adenomas, including 12 untreated and eight recurrent cases, 17 other benign parotid tumours, and 12 malignant tumours. T1- and T2-weighted images and Gd-DTPA enhanced T1-weighted images were obtained. Characteristic bright signals with a higher intensity than that of CSF were seen in all of the pleomorphic adenomas on T2-weighted images, and were found to represent myxoid areas histologically. Although the cystic spaces in some benign tumours produced bright signals, these areas were distinguished from myxoid areas due to nonenhancement with Gd-DTPA. No bright signals were seen in the malignant tumours. In conclusion, bright signals on T2-weighted images represent myxoid tissue and are useful findings for diagnosing pleomorphic adenomas.

Decreased deformability of red cells in refractory anemia and the abnormality of the membrane skeleton

Rheological characteristics of red cells in two patients with refractory anemia (with single chromosomal abnormality of 20q- or 13q-, respectively) were investigated with the hematological and biochemical properties. (1) Whole blood viscosity was remarkably increased, and the red cell deformability was greatly impaired (the impairments were prominent in patient with 20q-). (2) The hematocrit of both patients was about half of the normal value. Remarkable anisocytosis with elliptocytes and poikilocytes was observed in the patient with 20q-, but the anisocytosis was not so prominent in the patient with 13q-. (3) 2,3-diphosphoglycerate content in red cells was markedly increased in both patients, but adenylate content was not. (4) The red cells were slightly resistant to osmotic hemolysis, but they were not heat-labile. (5) Structural abnormality of spectrin was suggested from the impaired dimer-dimer association in red cell membrane and from the different susceptibility of spectrin to tryptic digestion. In conclusion, the rheological impairments and the abnormal shape of red cells in refractory anemia probably originated from the structural abnormality of cytoskeletal proteins in membrane, and the functional and structural abnormality may be different among patients.

Carbohydrate-related regulation of the ethanol-induced increase in serum gamma-glutamyl transpeptidase activity in adult men

The dietary influence on ethanol-induced increase in serum gamma-glutamyl transpeptidase (gamma-GTP) activity was studied in 2165 healthy men 18-85 y of age living in Nagano Prefecture, Japan. As ethanol consumption increased, the intake of cereals, potatoes, vegetables, milk and dairy products, oils, fruit, confections, and sugar decreased, whereas the intake of meat increased. These associations suggest that ethanol consumption led to the decrease in the intake of carbohydrate and vegetable fat. Serum gamma-GTP activity was found to be positively related to ethanol consumption and negatively related to the intake of sugar, fruit, and confections. The activity was the highest in those whose percent energy intake from carbohydrates was the lowest. Stepwise-multiple-regression analysis identified the three variables ethanol, sugar, and fruit, as the factors associated with the value of gamma-GTP activity: ethanol on the one hand increased the activity, whereas sugar and fruit on the other hand decreased the activity. Moreover, a lowered sugar intake augmented the ethanol-induced increase in the enzyme activity. These results suggest that sugar intake plays a role in the ethanol-induced increase in serum gamma-GTP activity.

Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections

Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common.

Effects of azelastine on membrane currents in tracheal smooth muscle cells isolated from the guinea-pig

Azelastine [4-(p-chlorobenzyl)-2-(hexahydro-1-methyl -1H-azepin-4-yl)-1-(2H)-phthalazinone hydrochloride], an anti-allergic agent, inhibited the high K(+)-induced contraction in tracheal smooth muscle cells isolated from the guinea-pig. In order to investigate the ionic mechanisms, we examined the effects of azelastine on membrane currents, using the tight-seal whole cell voltage clamp technique. Azelastine (1-100 microM) caused an inhibition of the Ba2+ inward current (IBa) through the voltage-dependent L-type Ca2+ channel in a concentration-dependent manner. The inhibitory effect of azelastine on IBa was fully reversible. The IC50 value for azelastine-induced inhibition of IBa was approximately 8 microM, and 100 microM azelastine completely suppressed IBa. Azelastine exerted mainly a tonic block of IBa but did not show use dependence. Azelastine (10 microM) shifted the quasi-steady-state inactivation curve of IBa to more negative membrane potentials by approximately -20 mV, suggesting that the inhibitory effect of azelastine on IBa was voltage-dependent. In addition, azelastine produced inhibitory actions on other membrane currents (i.e. the voltage-dependent transient outward K+ current and the Ca(2+)-activated oscillatory K+ current) at doses higher than 10 microM. These results suggest that azelastine inhibits the voltage-dependent L-type Ca2+ current in single tracheal smooth muscle cells, which may contribute to the anti-allergic actions of azelastine in airways.

Serum pepsinogen as a new marker for gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.

METHODS

Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.

RESULTS

The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.

CONCLUSIONS

These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.