Jinryo Takeda

Safe jugular and subclavian venipuncture under ultrasonographic guidance

Although jugular and subclavian venipuncture is a valuable technique and frequently utilized, blind venipuncture is at times associated with complications such as arterial puncture, pneumothorax, and malpositioning of catheters. We performed venipuncture under the guidance of high-resolution real-time ultrasonography, and these catheter-related complications were prevented. Jugular, subclavian and innominate veins and arteries, the pleura, and the lung are all delineated by supraclavicular and subclavicular scanning, and the needle and catheter can also be visualized. Ultrasonographically-assisted jugular and subclavian venipuncture is a simple and helpful procedure to carry out safe venipuncture. This method is particularly recommended for less experienced physicians and for more accurate puncture in patients with distorted cervical or subclavicular anatomic characteristics.

HLA class-I-restricted and tumor-specific CTL in tumor-infiltrating lymphocytes of patients with gastric cancer

Immune recognition of human cancers except melanoma is not well understood at either the cellular or the molecular level. We demonstrate in this study the existence of HLA class‐I‐restricted and tumor‐specific CTL in IL‐2‐activated TIL (tumor‐infiltrating lymphocytes) of all 4 gastric cancer patients tested. We established HLA A2‐restricted and adenocarcinoma‐specific CTL in 2 HLA A0201+ patients, and HLA A2402‐restricted CTL recognizing both adenocarcinoma and squamous‐cell carcinomas (SCC) in the 2 remaining HLA A2402+ patients. Further, HLA A3101‐restricted and adenocarcinoma‐specific CTL were established in 1 of the 2 HLA A2402+ patients who had HLA A3101 allele. HLA A2‐, A2402‐ and A3101‐restricted CD8+ CTL clones were established from these parental CTL lines. The 2 HLA A2‐restricted CTL lines lysed 8 of 13 HLA A2+ adenocarcinoma cell lines established from different organs (stomach, colon, lung and breast) with different subtypes (HLA A0201, A0206 and A0207). The HLA A2‐restricted CTL line recognized 9 and 6 different HPLC fractions of peptides eluted from the HLA A0201+ breast and HLA A0201+ colon adenocarcinoma cell lines, respectively. Allele‐specific deletion of HLA A2 or A24 molecules was observed in some tumor lines that were not susceptible to lysis by the CTL lines. These results suggest that TIL of gastric cancer possess CTL recognizing different peptide antigens binding to different HLA‐A alleles that are widely expressed on adenocarcinomas and also, to some extent, on SCC from different organs. Int. J. Cancer 70:631–638, 1997.

VEGF significance in peritoneal recurrence from gastric cancer

BackgroundIn gastric cancer, the management of peritoneal dissemination in the Peritoneal cavity is extremely important; however, peritoneal dissemination in the final stage of gastric cancer remains untreatable. Peritoneal dissemination involves several steps, including tumor-cell attachment, invasion, and growth in the peritoneum. Many cytokines, growth factors, matrix metalloproteinases (MMPs), and angiogenic factors play important roles in these steps. So far, few studies have investigated the correlation, if any, between peritoneal dissemination and the angiogenic factor, vascular endothelial growth factor (VEGF).MethodsImmunohistochemical staining, using the avidin-biotin peroxidase complex method, was performed on slides of surgical specimens from 40 patients with stage II gastric cancer with serosal invasion, who underwent surgery at our hospital between 1990 and 2000. Anti-human VEGF rabbit polyclonal IgG was used as the primary antibody. VEGF expression was classified in one of four categories depending on the percentage of tumor-cell staining (P). VEGF expression was also classified in one of three categories depending on the staining intensity (I). The VEGF expression score was calculated as P × I.ResultsThere were ten patients with peritoneal recurrence. Of these, seven had macroscopic type-4 scirrhous-type gastric carcinoma. In the immunohistochemical study, the VEGF score of patients with peritoneal recurrence was 9.40 ± 2.46; on the other hand, that of patients without peritoneal recurrence was 3.47 ± 2.36. The VEGF score of patients with peritoneal recurrence was significantly higher than that of patients without peritoneal recurrence. In patients with macroscopic type 4, the VEGF score of those with peritoneal recurrence was 9.14 ± 2.19, while on the other hand, that of the patients without peritoneal recurrence was 3.80 ± 3.03. The VEGF score of these patients with peritoneal recurrence was significantly higher than that of those without peritoneal recurrence. The survival rate in the VEGF low-expression group was significantly higher than that in the VEGF high-expression group. Multivariate analysis showed that the VEGF score was a significant parameter of peritoneal recurrence.ConclusionThese results suggested that VEGF was correlated with peritoneal metastasis from gastric cancer, and that VEGF was a useful indicator of peritoneal recurrence.

Experimental and clinical evaluation of the splenic capping method in the treatment of injured spleens

Polyglycolic acid elastic mesh was tailored and wrapped around the entire surface of experimentally injured spleens in 11 dogs, while carefully avoiding the splenic hilum, like a “hair-net”, to achieve complete hemostasis by compression. All 11 dogs survived the experiment with no postoperative bleeding observed. Histological examination, performed 6 weeks postoperatively, revealed histiocytes, fibroblastic proliferation with collagen and cellular collagenized fibrous tissue forming a neocapsule covering the spleen. Hematologically, the platelet count was increased at 2 weeks postoperatively, but subsequently decreased to within the normal levels by 4 weeks. We employed this splenic capping method clinically in four cases to avoid splenectomy and sufficient hemostasis with ultimate splenic recovery was achieved in each case without any abscess formation, postoperative bleeding, or complications related to the use of the mesh. These experimental and clinical results thus indicate the efficacy and safety of the splenic capping method for preserving the injured spleen.

A RARE CASE OF TESTICULAR NECROSIS AFTER SIGMOIDECTOMY FOR CANCER

症例は64歳，男性．左下腹部痛を主訴に来院した．精査の結果，S状結腸癌を認めS状結腸切除術を施行した．術中所見で，腫瘍は外側鼠径窩の位置で後腹膜に浸潤固定しており，同部位で精巣動静脈，精管を巻き込んでいた．精巣動静脈，精管を合併切除し腫瘍を摘出した．術後より発熱を認め左精巣は腫大した．超音波検査で血流信号がなく，血流障害による精巣壊死が疑われ手術を施行した．手術所見で，精巣は暗黒色に腫大し壊死しており左精巣摘出術を施行した．S状結腸切除に際し精巣動静脈合併切除をしても精巣は壊死しないのが一般的である．精巣への血流は精巣動脈だけではなく，外陰部動脈，精管動脈，挙睾筋動脈，膀胱動脈や前立腺動脈から血管が分枝し，さらにそれらが吻合枝を有しているからと考えられる．今回われわれは非常に稀な精巣壊死症例を経験したので若干の文献的考察を加えて報告する．

Evaluation of the cell kinetics of MNNG-treated rat gastric mucosa based on AgNOR and ODC activity

To investigate the process of carcinogenesis in gastric cancer, we studied the histological features and cell kinetics in the gastric mucosa of N-methyl-N′-nitro-N-nitrosoguanidine (MNNG)-treated rats. Samples of gastric mucosa from both MNNG-treated and control rats were histologically examined by staining with nucleolar argylophilic nonhistone (AgNOR) proteins, and their ornithine decarboxylase (ODC) activity was determined every 2 months for 10 months. In 40% of the MNNG-treated rats, atrophy of the gastric mucosa was observed after 2 months, followed by adenomatous proliferation. More AgNOR-positive granules were found in the pyloric glands than in the fundic glands, and the total number of positive granules increased over time. Cancerous and hyperplastic lesions preferentially developed in the pyloric glands and showed significantly more AgNOR-positive granules than the normal mucosa. After 6 months the ODC activity in the MNNG-treated rats was significantly higher than that in the control rats. These results thus suggest that the pyloric glands have a high growth activity, while in addition, adenomatous proliferation is a characteristic pathological feature of precancerous lesions in the stomach in MNNG-treated rats.

Expression of CD44 Molecule in Gastric Cancer

The expression of the CD44 molecule was investigated in 111 cases of a resected gastric cancer, and also in 5 gastric cancer cell lines. An immunohistochemical study using frozen sections revealed that the mucosal lymphocytes and the pyloric glands deep in the normal mucosa reacted to the anti-CD44 monoclonal antibody. 54 cases (48.6%) were stained on the cell surface involving the intercellular aspect. Well-differentiated cancer showed the highest frequency of CD44 expression, among the various histological types. Moreover, cases with extensive vascular invasion frequently expressed CD44 (75%) and CD44-positive cases had a significantly higher rate of metastasis to the liver than did negative cases. Flowcytometric analysis revealed expression of CD44 on the cell surface in one of 5 examined cell lines.

A study of the lymphatics in the stomach wall with hydrogen peroxide technique.

胃癌症例38例を対象に新鮮切除胃標本を過酸化水素法にて膨脹させ, 胃壁内リンパ管, とくに粘膜固有層表層毛細リンパ管を肉眼的, 組織学的に検討し, 以下の結果を得た.粘膜面からの肉眼的観察で白色の小斑が十二指腸輪状ヒダ部, 幽門腺および中間帯領域小弯部 (幽門腺萎縮と腸上皮化生が高度な部), 胃底腺領域皺襞部に多数観察され, 組織学的にこの小斑は過酸化水素法により膨脹された粘膜固有層の毛細リンパ管が密に分布する部位と一致した. 活性炭に切除標本を浸漬させた後過酸化水素法で処理した例では, 小斑部毛細リンパ管を含めリンパ管内に活性炭の流入が認められ, 小斑部毛細リンパ管が物質の吸収に関与しているものと思われた.

Diaphragmatic reconstruction using a latissimus dorsi muscle flap following wide resection of the diaphragm combined with esophago-gastrectomy for cardial cancer

In three patients with cardial cancer invading the esophagus and the diaphragm, wide resection of the left diaphragm and its reconstruction using a latissimus dorsi muscle flap were performed during radical esophago-gastrectomy. More than two thirds of the diaphragm could be resected because the muscle flap was large enough to be brought into the thoracic cavity without difficulty, to repair the diaphragmatic defect. The postoperative respiratory function of these patients was adequately maintained. A technique for diaphragmatic reconstruction by means of the latissimus dorsi muscle flap is described in this report.

CLINICAL AND PATHOLOGICAL ANALYSIS ON GASTRIC CANCER IN THE OLD AND PRACTICAL PLOBLEM IN TREATMENTS

高年者胃癌の特性と治療上の問題点を究明する目的で, 70歳以上の胃癌患者238例を対象として, 臨床的, 病理学的検討を行った.その結果, 1) 高年者胃癌は若年者胃癌と比較し, 性別, 占居部位, 肉眼型, 組織型で特徴的な所見が認められた.2) 臨床検査所見で75歳以上に特に心電図, 肺機能, 腎機能低下または異常を示す症例が多かった.3) 術後合併症発生率は, 70～74歳群で10.3%, 75歳以上群で14.9%で, 死亡率はそれぞれ, 6.0%, 8.5%で, 肺合併症々例に死亡率が高かった.4) 治癒切除率は70～74歳群が50.0%, 75歳以上群で31.9%であったが, 治癒切除では予後が期待出来ることから, 肉体的, 精神的条件が許すならば, R2郭清をめざした根治的手術を行うことが望ましい.