Hideharu Fujita

Carcinosarcoma of the esophagus. An immunohistochemical and electron microscopic study.

Immunohistochemical and electron microscopic examinations were made of a carcinosarcoma of the esophagus in an 80‐year‐old man. An immunohistochemical examination showed that sarcomatous spindle cells were vimentinpositive, whereas squamous carcinoma cells were keratin‐positive. No coexistence of vimentin and keratin in a single tumor cell was found. Electron microscopically, the sarcomatous spindle cells were characterized by well‐developed rough endoplasmic reticulum, abundant intermediate filaments, and the occasional presence of peripheral aggregates of microfilaments. No definite desmosomes were identified among these cells. These results appear to indicate that most of the spindle‐shaped tumor cells assume fibroblastic cellular features and synthesize the intermediate filament protein usually expressed in mesenchymal cells, even though such tumor cells could be epithelial in origin.

Overexpression of phosphorylated histone H3 is an indicator of poor prognosis in gastric adenocarcinoma patients.

Ki-67 immunostaining is commonly used for assessing cell proliferation, but studies of its use as a prognostic indicator have revealed discordant results in gastric cancer patients. Recently, antibodies for phosphorylated histone H3 have been used to identify dividing cells because of its precise overexpression in mitosis. The authors tested the hypothesis that phosphorylated histone H3 overexpression might be a good prognostic indicator for gastric cancer patients by conducting an immunohistochemical comparison with Ki-67 in gastric cancer samples. One hundred twenty-two surgically resected primary cases were selected and histologically categorized in accordance with Laurens classification. No correlation was found between phosphorylated histone H3 and Ki-67 regarding overexpression. However, correlations between phosphorylated histone H3 overexpression and clinicopathologic variables were noted for histologic type (intestinal type predominant in high labeling indices [LIs], defined as over the value of the 75th percentile; P<0.01), vessel invasion (positive in high LIs; P=0.05), and lymph node metastasis (positive in high LIs; P=0.04). With regard to Ki-67 overexpression, no correlation was evident with the clinicopathologic variables except histologic type (intestinal type predominant; P=0.05). By the Kaplan-Meier method with the log-rank test, cases overexpressing phosphorylated histone H3 showed a poorer prognosis than cases with low expression (P<0.01). In contrast, Ki-67 expression did not influence prognosis. Multivariate analyses indicated phosphorylated histone H3 overexpression to be an independent prognostic factor, together with lymphatic invasion and venous invasion (P<0.01). In conclusion, it seems likely that phosphorylated histone H3 plays an important role in the prognosis of gastric cancer, and its immunohistochemical investigation is useful for the prediction of prognosis in gastric cancer.

Management of pancreatic pseudocysts in 42 patients with inflammatory or traumatic cysts

In attempts to determine and appropriate treatment for pancreatic pseudocysts, forty-two cases were reviewed. Twenty-three were inflammatory and nineteen were traumatic. Elevation of serum amylase levels and white blood cell count occurred more frequently in patients with traumatic cysts than in those with inflammatory ones. Filling of the pseudocysts occurred in eleven of twelve patients in whom endoscopic retrograde pancreatography (ERP) had been performed. Spontaneous regression of the cysts occurred more frequently in those with traumatic cysts (42 per cent) than in those with inflammatory cysts (26 per cent). Excision of the cysts were performed in seven of twenty-three patients with inflammatory cysts; external drainage in five with inflammatory cysts and in one with traumatic cysts; and internal drainage in five with inflammatory cysts and ten with traumatic cysts. There was a recurrence of the cysts in two patients, one due to multiple stenosis of the pancreatic duct located to the right of the resected cysts, and the other was caused by an anastomotic stenosis of the cystogastrostomy. One persistent pancreatic fistula following external drainage was treated by fistulogastrostomy. We recommend the evaluation of the condition of pancreatic duct by ERP for individualizing pancreatic pseudocysts.

High labeling indices of cdc25B is linked to progression of gastric cancers and associated with a poor prognosis.

To clarify the significance of cdc25B, which plays an important physiologic role in regulation of the G2/M check point, in progression of gastric cancer, 125 samples of paraffin-embedded gastric cancers were investigated by immunohistochemistry. In addition, 3 human gastric cancer cell lines were studied to determine the cellular localization of cdc25B by immunohistochemistry and cell fractionation followed by Western blotting. In the cell lines cdc25B was found to be present in both nuclei and cytoplasm, but predominantly in nuclei. High labeling indices of cdc25B in invasion front of gastric cancer was observed in 31 out of 125 cases (24.8%), linked to an advanced depth of cancer invasion (P=0.02), high rates of lymphatic invasion (P=0.03), and lymph node metastasis (P<0.01). Furthermore, the Kaplan-Meier method demonstrated a poor prognosis for cdc25B high labeling indices cases (P=0.02), although multivariate analysis revealed it not to be an independent factor. In conclusion, it seems likely that cdc25B is located predominantly in nuclei when overexpressed and this has some linkage with progression of gastric cancer.

A case of short bowel syndrome managed by home elemental enteral hyperalimentation.

はじめに 小腸広範切除後に発症する短腸症候群においては栄 養管理は重要な問題である。以前は残存小腸の長さが 40cm以 下では管理は困難であるとされ1ち最近では経 静脈的高カロリー輸液 (intravenOus hyperalimenta― tion,以下 IVH)や 成分栄養剤(elemetal diet以下 ED) による経腸栄養法などの栄養管理法の進歩によりその 生命的予後は次第に改善されてきたものの,家 庭生活 への復帰はいまだ困難である。われわれは自己挿管に よる経鼻チュープを通 して夜間のみ EDを 注入する在 宅経腸栄養法の実施により,家 庭生活への復帰が可能 であった短腸症候群の 1例 を経験 したので報告する。 症 例 症fllは71歳の男性で,昭 和55年に上行結腸癌のため 結腸右半切除術の既往を有 し,家 族歴には特記すべき ことはない。昭和60年 7月 上旬よリイレウス症状のた め他院に入院していたが,腹 膜刺激症状が出現してき たため 7月 14日に当科へ紹介され,絞 施性イレウスの 診断にて緊急手術が実施された。 正中切開で開腹するに,腹 腔内に中等量の血性腹水 を認め,小 腸間膜の軸捻転のため Treitz観常の約25

EFFECT OF INTRAVENOUSHYPERALIMENTATION ON ANASTOMOTIC FAILURE OF GASTROINTESTINAL TRACT

縫合不全に対する高カロリー輸液 (IVH) の治療効果を検討した.縫合不全症例147例を, IVH (+) 69例, IVH (-) 78例の2群に分け, それぞれを重症度別にI度からIV度に分類した.全体の治癒率ではIVH (+) 58.0%, IVH (-) 44.9%で大差はなかったが, 重症度に応じた治癒率では, I度100%: 100%, II度100%: 91.3%, III度52.6%: 24.3%, IV度38.9%: 0%で重症例において明らかにIVHの効果がみられた.II度とIII度について, 自然治癒までの期間を比較したところ, II度14日: 40日, III度22日62日とIVH (+) で治療期間の著明な短縮を認めた.敗血症の発生, インシュリンの使用頻度では重症, 軽症間に差はなく, 縫合不全に対するIVHの効果が確認された.