Esophagogastrostomy reconstruction after limited proximal gastrectomy

BACKGROUND/AIMS

Recent advances in diagnostic techniques have led to the detection of an increasing number of early gastric cancers in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for these cancers.

METHODOLOGY

The clinicopathologic characteristics of 35 patients with early gastric cancer in the upper third of the stomach who underwent three different types of gastrectomies were reviewed retrospectively from hospital records between January 1992 and August 1999.

RESULTS

Patients undergoing limited proximal gastrectomy with esophagogastrostomy reconstruction had shorter operation times and less blood loss than those for patients undergoing total gastrectomy or proximal gastrectomy with jejunal interposition. No lymph node metastasis was identified in any of these patients. Heartburn due to reflux esophagitis was seen in a few patients of each group, but they were successfully treated by antacids. The extreme reduction in food intake volume was more frequently experienced in patients with total gastrectomy than those with both proximal gastrectomies. When mortality due to other disease was excluded, all patients survived without recurrence.

CONCLUSIONS

A limited proximal gastrectomy with esophagogastrostomy reconstruction decreased surgical risk and realized preservation of maximal function.

Kindling of the midbrain periaqueductal gray in rats

We investigated the role of midbrain periaqueductal gray matter (PAG) in the manifestation of generalized seizures by administering electrical stimulation to this area in rats. Electrical stimulation of 60 Hz biphasic square pulses of a 1-s duration administered to the PAG-induced convulsive responses in the following order: (1) Type I, running (stimulus intensity; range 50--200 microA, mean 73.1 microA) without afterdischarge (AD), (2) Type IIa, running (stimulus intensity; range 50--300 microA, mean 111.8 microA) with AD at the PAG and the amygdala (AMY), and (3) Type IIb, generalized tonic--clonic seizures (GTCS) (stimulus intensity; range 50--250 microA, mean 182.1 microA) with AD at the PAG and AMY. Twenty daily PAG stimulations at the non-GTCS inducing threshold failed to produce kindling. However, 20 daily PAG stimulations at the GTCS threshold produced progressive AD spread involving the motor cortex, and progressive changes in the behavioral seizure pattern. These findings indicate that the PAG can be effectively kindled. However, PAG kindling has no apparent influence on subsequent AMY kindling.

Convulsive seizures induced by N-methyl-D-aspartate microinjection into the mesencephalic reticular formation in rats

Effects of microinjections of a single 2 or 10 nmol dose of N-methyl-D-aspartate (NMDA) into the unilateral mesencephalic reticular formation (MRF) on behavior and electroencephalogram were examined in rats (n=18) during a 15 min period (Exp. 1), and subsequent effects of sound stimulation with key jingling applied at 15, 30, and 45 min after the injections were observed (Exp. 2). The microinjections of 2 nmol dose of NMDA (n=10) induced hyperactivity (9 of 10 rats) and running/circling (8 of 10 rats) in Exp. 1, and hyperactivity (3 of 10 rats) in Exp. 2. Moreover, the microinjections of 10 nmol dose of NMDA (n=8) induced not only hyperactivity (8 of 8 rats) and running/circling (7 of 8 rats) but also generalized tonic-clonic seizures (GTCS) (5 of 8 rats) in Exp. 1; these seizure patterns were also elicited by sound stimulation in Exp. 2. The seizure patterns were accompanied by electroencephalographic seizure discharges in the MRF and the motor cortex. In contrast, the control group rats (n=10) which received a single dose of saline microinjection into the unilateral MRF showed no behavioral or electroencephalographic changes in both Exp. 1 and 2. These findings suggest that the MRF has an important role in the development of GTCS, which follows hyperactivity and running/circling, and that potentiation of excitatory neurotransmission in the MRF participates in the development of audiogenic seizures as well as GTCS.

Molecular detection of disseminated cancer cells in the peripheral blood and expression of sialylated antigens in colon cancers

BACKGROUND AND OBJECTIVES

To improve the survival rate of patients with colon cancer, liver metastases must be eradicated in a clinically occult state. This study was designed to find a predictor for potential liver metastases or micrometastases in colon cancer.

METHODS

Peripheral blood samples and tumor specimens were obtained from 36 patients with colon cancers. The blood samples were subjected to reverse transcriptase-polymerase chain reaction (RT-PCR) analysis, and the expression of sialylated carbohydrates was also investigated in the tumors immunohistochemically.

RESULTS

A carcinoembryonic antigen (CEA)-specific signal in the blood was detected in 9 of 12 (75%) patients with liver metastasis and in 8 of 24 (33%) patients without liver metastasis, respectively (P < 0.05). The positive rates of sialyl Lewis A (sLeA) and sialyl Lewis X (sLeX) were 36.3% and 40% in tumors without liver metastasis vs. 58.3% and 100% with liver metastasis, respectively. Within a year after surgery, liver metastases became clinically evident in three of the four patients without liver metastasis who showed a CEA-positive signal in their blood preoperatively and who had tumors with a strong expression of sLeX.

CONCLUSIONS

A combination of both markers may provide prognostic information for liver metastases in colon cancer.

[Investigation of the actual conditions of hospital nurses working on three rotating shifts: questionnaire results of shift work schedules, feelings of sleep and fatigue, and depression]

These studies were performed to clarify (1) the actual conditions concerning rotating shift schedules of nurses in Japanese university and college hospitals and to evaluate (2) some aspects of the physical and mental health, and (3) sleep profile of hospital nurses working on counter-clockwise shift rotation. Two questionnaire surveys and the OSA sleep inventory (OSA) were carried out. The subjects in the study (1) were a total of 80 nursing directors in university and college hospitals. The questionnaire covered 4 categories, such as the schedule most frequently adopted and reasons for using the schedule. The questionnaires were returned by 67 directors (83.8%). The subjects in the study (2) were 189 nurses working on three-shift work schedules at Asahikawa Medical College Hospital. The items in the questionnaire covered 7 categories, as follows: 1) feeling of sleep after each shift (8 items); 2) feeling of fatigue after each shift (30 items); 3) physical symptoms; 4) inter-personal problems; 5) all the items on Zung's self-rating depression scale (SDS); 6) all the items on the Horne and Ostberg morningness-eveningness questionnaire; and 7) 24 items on the Maudsley personality inventory. The questionnaires were returned by 156 nurses (82.5%), whose mean age and duration of shift-work employment were 27.2 +/- 5.1 and 5.0 +/- 4.3 years (mean +/- SD), respectively. For 152 nurses (97.4%) of those returning the questionnaire, the working schedule consisted of 2 consecutive night shifts and 2 consecutive evening shifts, following a variable number of day shifts (rapid and counterclockwise shift rotation). The subjects in the study (3) were 8 healthy nurses working on above-mentioned three rotating shifts at the psychiatric ward of Asahikawa Medical College Hospital, whose mean age was 29.4 +/- 5.8 years (mean +/- SD). All the subjects recorded their sleep-logs and underwent OSA everyday for 30 consecutive days. Of the 240 OSA data, 95 data (16 after day shift, 17 after the 1st night shift, 16 after the 2nd night shift, 15 after the 1st evening shift, 16 after the 2nd evening shift, 15 after day off) were analyzed. In addition to five of sleep factors in the OSA analysis, we evaluated the global score (GS), which represents subjective global feeling of sleep. In the study (1), 47 of 66 hospitals (71.2%) adopted rapid and counterclockwise shift rotation. The results of study (2) were as follows: 1) After the first night shift (diurnal sleep), the sleep problems were worst, and the frequency of taking sleep-inducing drugs was highest (12.6%); 2) Feelings of fatigue were the highest level after each of the two night shifts; 3) SDS score was relatively high (57.8 +/- 8.1, mean +/- SD); 4) The older the nurse, the greater the aggravation of both sleep problems and fatigue; 5) Sleep problems after day shifts were worse and SDS score was higher in nurses classified as "nightowls" compared to those in nurses classified as "morning people"; and 6) There was no difference between introverts and extroverts in sleep problems, fatigue or SDS score. The results of study (3) were as follows: 1) In 3 of sleep factors (Sleepiness, Integrated sleep, sleep initiation) and GS, there were significant differences among each rotating shift schedule including day off; 2) The highest score in five of sleep factors and the highest GS were noted after the 2nd night shift (nocturnal sleep), and the lowest after the 1st night shift (diurnal sleep); and 3) The younger subjects (n = 4; mean age, 24.5 years) showed a higher GS compared with that of the older subjects (n = 4; mean age, 34.2 years).

Effect of postnatal anoxia on seizure susceptibility in rats: bicuculline-induced seizures and pretreatment with iproniazid

The effects of anoxia at 10 days of age on seizures induced by bicuculline (BIC), a specific antagonist of gamma-aminobutyric acid (GABA), and BIC-induced seizures after pretreatment with iproniazid (IPR), a monoamine oxidase inhibitor, were investigated in male adult rats. The rats with postnatal anoxia (Group A) were significantly more susceptible to BIC than the control rats (Group C). On the other hand, BIC-induced seizures in both groups were suppressed by IPR pretreatment. Especially, the suppression of BIC-induced seizures which was made by pretreatment with IPR at small doses was more apparent in Group A as compared with Group C. The present study suggests that the enhanced seizure susceptibility of adult rats with postnatal anoxia involves brain monoaminergic system.