Bunzo Nishioka

Doubling time of serum CA 19-9 in the clinical course of patients with pancreatic cancer and its significant association with prognosis.

Pancreatic cancer is generally a disease with a poor prognosis, and relationship between change of serum CA 19‐9 level and progression of this disease was investigated with regard to clinical pace of disease and tumor growth.

Physiologic status of the anorectum following sphincter-saving resection for carcinoma of the rectum

The physiologic status of the anorectum after low anterior resections or pull-through operations of the rectum was evaluated clinically and by manometric studies. It was demonstrated that the presence of a normal anal resting pressure and an anorectal reflex were important to achieve postoperative continence after sphincter-saving operations. In patients with anastomotic leaks and poor function, a marked high-pressure zone in the anal canal and an anorectal reflex were not found, but as local inflammation resulting from the anastomotic leak disappeared, these parameters returned to normal. A normal anorectal reflex was found in one of three patients after Bacon-type pull-through operations, but the remaining two showed an increase of anal canal pressure during colonic distention. These results indicate that an elevation of anal-canal pressure in response to colonic distention plays a significant role in fecal continence at the time of “a sense of urgency” if internal sphincter function is impaired.

Conservative surgery for regional lymphadenectomy in the treatment of early gastric carcinoma

The relationship between lymph node metastases and postoperative prognosis in 209 patients with early gastric cancer was studied. As to the postoperative prognosis in relation to the extent of lymph nodes dissection, no significant difference was observed among the age-corrected 5-year survival rates following three surgical procedures in patients with early gastric cancer. Age-corrected 5-year survival rates were 0.92±0.44 R1-resection, 0.95±0.44 in R2-resection, and 1.00±0.06 in R3-resection, respectively. In addition, in 71 patients including 33 with early gastric cancer and 38 patients with advanced but relative early gastric carcinoma, the relationship between the immunostatus and postoperative prognosis was investigated. Postoperative age-corrected 5-year survival rate (0.904±1.153) of the optimal responders with good immunostatus was significantly higher than that (0.582±1.153) of the suboptimal responders with impaired immunostatus (P<0.01). Thus, conservative surgery for regional lymphadenectomy may be an effective procedure for cure of early gastric carcinoma, particularly in cases of a carcinoma limited to the mucosal area of the stomach.

Basic experiments on oral administration of 5-fluorouracil emulsion as adjuvant chemotherapy to surgical treatment for gastric cancer.

Oral administration of 5-fluorouracil (5-FU) emulsion was compared experimentally with that of 5-FU aqueous solution as to the degree of absorption and tissue distribution. After oral administration of both the 5-FU emulsion and the 5-FU solution, 5-FU was detected at the highest level in both the stomach and the duodenum. This seems to suggest that 5-FU is strongly affinitive to the tissues of the gastrointestinal tract. As to the relative concentration of these two forms of the drug, the oral administration of the 5-FU emulsion resulted in a maximum value 1.5 times higher than that of the 5-FU solution. An appreciable concentration of 5-FU was maintained for a considerably long time with the administration of 5-FU emulsion. In the lymph, the maximum level of the 5-FU emulsion was three times higher than that of the 5-FU solution. The drug concentration of the 5-FU emulsion remained higher than that of the 5-FU solution through the entire duration of the experiment. Regarding the drug concentration in the regional lymph nodes, the pattern demonstrated was almost the same as in the lymph itself.It is expected that the oral administration of 5-FU emulsion may be useful as an adjuvant to the surgical treatment of gastric cancer, because of the high drug concentration resulting both in the gastrointestinal tract and in the regional lymph nodes.

A Manometric Assessment of Anorectal Pressures and its Significance in the Diagnosis of Hirschsprung's Disease and Idiopathic Megacolon

Anorectal manometric studies were performed on nine patients with Hirschsprungs disease and ten patients with idiopathic megacolon for the purpose of differentiation, comparing with those of the normal subjects. The anorectal reflex was absent in all nine of the patients with Hirschsprungs disease while in all of ten patients with idiopathic megacolon rectal distension produced a relaxation in the anal canal like that of the normal subjects. Manometric studies proved to be a reliable and noninvasive technique for the diagnosis of Hirschsprungs disease and were of particular value as simple screening tests in patients with a clinical suggestion of this disease.The manometric studies of the patients with Hirschsprungs disease or idiopathic megacolon in the present series also demonstrated that the pronounced internal sphincter contraction combined with a total absence of reflex relaxation or an inadequate response of the sphincter to rectal distension might be responsible for the obstructive symptoms in these diseases.

Anal sphincter function and rectal reservoir after sphincter saving operations for carcinoma of the rectum

Anal sphincter function and rectal reservoir were studied in 27 patients after low anterior resection, in 6 after Welch or Turnbull type pull-through surgery and in 3 after Bacon type pull-through surgery. Sixteen patients who had undergone right hemicolectomy served as a control group. Anal sphincter function immediately after low anterior resection was diminished, but improved during the following 6 months. Rectal capacity was much reduced immediately after surgery, but increased with time, and the neorectum could to some extent adapt to its new role as a reservoir. After pull-through operations, anal canal pressure and rectal compliance were significantly lower than after low anterior resection or right hemicolectomy. These findings may explain the increased frequency of bowel action after pull-through operations.

Histological evaluation of the effect of 5-FU emulsion on lymph node metastasis of stomach cancer

In order to evaluate the effect of anticancer drugs on the metastatic lesions of the regional lymph nodes from stomach cancers removed after oral administration of 5-FU emulsion, histological examinations of the specimens obtained from 107 surgical cases were carried out. In additional 13 cases with gastric cancer, the active 5-FU concentrations in the regional lymph nodes were determined.The effect of 5-FU emulsion in metastatic lesions as determined was histologically classified into Grades 0 to III according to the severity and extent of damaged cells and cell nests Grades II and III were judged to demonstrate the beneficial effect of the 5-FU emulsion. Such changes were identified in 62.0 per cent of the 242 metastatic lymph nodes, and the effectiveness increased as the total dose of the 5-FU emulsion administered increased (50.9 per cent for 5,000 mg or less, 70.9 per cent for 5,000 to 6,000 mg, and 72.7 per cent for 6,000 mg or more). The rate of effectiveness also varied with the histological type of the primary carcinoma, i.e. the differentiated type being more sensitive.The mean active 5-FU level in the regional lymph nodes was higher after the administration of 5-FU emulsion than of 5-FU solution supporting the earlier animal experiments.

Detection of gastric cancer by a combination of tissue polypeptide antigen (TPA), lipidbound sialic acid (LBSA) and carcinoembryonic antigen (CEA)

SummaryIn this study, the clinical significance of the tumor markers, tissue polypeptide antigen (TPA) and lipid-bound sialic acid (LBSA) in conjunction with carcinoembryonic antigen CEA, was tested in 52 gastric cancer patients. The incidence of elevated serum levels of these 3 markers was as follows: 63% (33/52) for TPA; 40% (21/52) for LBSA; 21% (11/52) for CEA. In a combination assay using all three tumor markers, 37 out of 52 gastric cancer patients (71%) showed a positive combination assay, while 5 out of 20 normal subjects (25%) showed a positive combination assay. In a discriminant analysis of the resulting data, 18 out of 52 gastric cancer patients (35%) were classified correctly based on an analysis of CEA alone. Furthermore, 25 out of 52 gastric cancer patients (48%) and all 20 normal subjects (100%) were classified correctly based on an analysis of all three variables.Our data suggest that TPA and LBSA are more sensitive than CEA as markers of gastric cancer, and that the simultaneous measurement of TPA and LBSA in conjunction with CEA is more useful in cancer detection than the measurement of CEA alone.

Immunoreactive carcinoembryonic antigen in gastric juice in patients with gastric cancer

To clarify the significance of immunoreactive carcinoembryonic antigen in gastric juice (gastric CEA) from gastric cancer patients, we studied the gastric CEA in comparison with cancer progress, histologic types of tumors, staining, for CEA and extent of intestinal metaplasia. The gastric CEA levels from patients with other gastric diseases, i.e., gastric ulcer, duodenal ulcer and chronic gastritis were also investigated. The mean gastric CEA level from gastric cancer patients was significantly higher than from gastric or duodenal ulcer patients, but there was no significant difference between levels in patients with gastric cancer and in those with chronic gastritis. The gastric CEA levels from cancer patients increased with progression of the cancer. The differentiated carcinomas showed significantly higher gastric CEA levels than the poorly differentiated carcinomas. Positive CEA tumors showed significantly higher gastric CEA levels than did the negative CEA tumors. The tumors with diffuse intestinal metaplasia revealed high gastric CEA levels. Determination of gastric CEA levels is considered to be useful for screening of gastric cancer.

Flow cytometric analysis of nuclear DNA content in the endoscopic biopsy tissues of gastric cancer

The nuclear DNA content was measured by flow cytometry in gastric cancer patients using endoscopically biopsied tissue specimens. When the specimens were classified into diploid and aneuploid according to the DNA histogram, 56% (65/117) of the specimens were aneuploid. and advanced cancer was clearly more often aneuploid than early cancer. The frequency of aneuploidy appeared to be higher as the histologic depth of cancer was greater. Noncancerous tissues of the stomach were mostly diploid. The nuclear DNA ploidy pattern in gastric cancer cells could be analyzed by using endoscopic biopsy samples and this flow cytometric investigation would be possibly contributive to further characterization of gastric cancer in the diagnostic procedure of malignancy.