Hisatomo Futawatari

Clinico‐pathological Evaluation of Repeated Intratumoral Injection Therapy of OK‐432 for Inoperable Gastric Carcinomas

Abstract: Fifteen patients with inoperable gastric cancer underwent repeated intratumoral injections of OK‐432, a streptococcal preparation, through an endoscope. Seven patients showed a reddened tumor surface following the initial two or three injections, and in most of these a remarkable change in configuration followed. Two of these patients showed complete macroscopic disappearance of the tumor and three had a marked reduction, while eight patients in who no color change initially appeared later showed no or minor morphological changes. Finally, five among fifteen patients showed excellent local responses, and rate of effectiveness was estimated as 33.3%. There seemed to be no correlation between the effectivity and the patients background factors. In ten patients for who serial histological findings were obtained by biopsy, inflammatory cellular infiltration to the tumor parenchyma had apparently increased. Among these, plasma cell was predominant in five patients, while lymphocytic predominancy was seen in three and neutrophil predominancy was seen in two patients. The rate of effectiveness was the highest in the plasma cell dominant patients. The systemic immunological responses were determined by measuring skin tests for delayed hypersensitivity and phytomitogen blastogenesis which failed to reveal a significant enhancement of the reactivity except in the case of the PPD skin test. In terms of the survival rate, there was no significant difference between these patients and patients who were otherwise treated. However, among the patients who received injections of OK‐432, a prolonged survival rate was obtained in patients with a good local response compared with those who had a poor response or no response.

Anomalous arrangement of the pancreatico-biliary ductal system. Present and future.

発生学上の問題をはじめ非常に多くの問題が現時点で未解決である.膵炎は23%に合併する.膵石合併時の手術は膵石摘除が必要で, 胆管拡張部切除に膵管切開を加えるも可である.胆道癌も23%に合併する.発癌機序には胆道内容中に増加した二次胆汁酸 (DCA, LCA) が関与する可能性を示した.組織内CEAが癌浸潤部に強く染色された.癌予防の見地から, 胆道非拡張例にも積極的に胆摘・膵液胆汁分流手術が, 拡張症とくに嚢胞状拡張症では肝側, 十二指腸側ともに拡張部完全摘除が必要である.再建法は胆管十二指腸端側吻合が侵襲小さく, 生理的である.合流異常は形成異常である以上, より生理的状態に近づける手術的治療は21世紀にも基本的には必要であろう.