Keiichi Yoshino

Experimental and clinical studies on the intraperitoneal administration of cis-diamminedichloroplatinum (II) for peritoneal carcinomatosis caused by gastric cancers.

The effectiveness of the intraperitoneal administration of cis-diamminedichloroplatinum (II) (DDP) on peritoneal carcinomatosis caused by gastric cancers was evaluated. Seventeen patients were treated with one of three protocols, consisting of the intraperitoneal injection (ip) of DDP at doses of 70 and 110 mg/m2, with or without sodium thiosulfate (STS) rescue. The area under the curve (AUC) of DDP for sufficient anticancer activities against cultured human cell lines in vitro was estimated at 240 μg h/ml, which was equivalent to the AUC gained by 110 mg/m2 ip DDP in the clinical studies. The cytotoxic activity of DDP was reduced by approximately 50% with 100-fold STS in the AUC in the experimental studies. However, this was achieved only in urine, and not in either the peritoneal cavity or in plasma in the clinical studies. Three cases of a partial response against peritoneal carcinomatosis were seen from a total of four evaluable cases treated with 110 mg/m2 DDP, and no renal toxicities were observed in those treated with the STS rescue. The results of this study led us to conclude that high-dose ip DDP treatment combined with the STS rescue would be useful chemotherapy against peritoneal carcinomatosis caused by gastric cancers.

Laparoscopy-assisted total gastrectomy for advanced gastric cancer with carcinomatous ascites after S1 plus cisplatin chemotherapy: a case report.

A 29-year-old man with a type 4 tumor, in the lower third of the stomach, and carcinomatous ascites was diagnosed by aspiration cytology of the ascitic fluid. Curative resection was considered impossible, and S1 (120 mg/d) and cisplatin (90 mg/d) were given for 21 days in 1 course. The cancer lesion showed marked remission (partial response), and the ascites completely disappeared after the fourth course. Twenty-five days after completion of the S1 treatment, laparoscopy-assisted total gastrectomy was performed. Histopathological examination showed no remnant cancer cells in the resected specimen and no lymph node metastases. The tumor was replaced with fibrosis having a granulomatous change. The patients postoperative course was uneventful. The patient was continued with S1 monotherapy after surgery, and no signs of recurrence or metastases have been seen on any examination 12 months after the surgery.

Endoscopic Mucosal Resection of Early Gastric Cancer. Indications and Limitations.

切除早期胃癌252例を対象にリンパ節転移率の検討を行った後, 内視鏡的粘膜切除 (EMR) を51例に施行し, 次の結果を得た.(1) Ul (-) のm癌ではリンパ節転移が認められず, EMRの積極的適応となる.(2) EMRの技術として, 反復把持法を用いると, 切除粘膜の長径は平均2.2cmで, 胃内のほとんど全部位でEMRが可能であった.(3) 合併症としては穿孔1例と出血2例を経験したので, 防止対策を検討した.(4) 完全切除33例の再発は0%であるのに対し, 分割切除例では, 4-18か月以内に50%が再発した. (5) EMR前後の比較で, EMRによるQOLの低下は認めなかった.EMRの安全適応限界は, EMR切除標本で, 深達度m, 病巣内にU1 (-), 断端 (-) であり, 患者のインフォームドコンセントを得て, 内視鏡的経過観察の条件が得られれば, 胃切除術に勝る根治療法とみなしうる.

The Role of Selective Celiac Angiography to Anticipate Prognosis of Type 4 Gastric Cancer.

Borrmann 4型胃癌の術前の予後予測手段として選択的腹腔動脈造影法 (SCA) の有用性を検討した.対象はBorrmann 4型胃癌の切除症例76例で肉眼所見により巨大皺襞型 (23例) と潰瘍びまん浸潤型 (53例) に分類した.SCA所見として胃壁動脈狭小化 (A) と胃壁静脈消失 (V) をとりあげた.潰瘍びまん浸潤型, 巨大皺襞型のいずれの群についてもAV陰性群 (A, V共に陰性) はAV陽性群 (A, V両者または, いずれか一方陽性) より予後良好と考えられ, とくに巨大皺襞型で生存曲線に有意差を認めた.巨大皺襞型のうち外科的に良好な予後が期待される肉眼的治癒切除例において, 術後50%生存期間はAV陰性群7例で24か月, AV陽性群7例で9か月であり, 生存曲線でも有意の差を認めた.これらの検討によりSCA像は術前の予測判定に有用な指標と考えられた.

Mechanism of metastasis of gastric cancer, from the viewpoint of basement membrane degradative enzyme.

上皮性癌の転移過程では, まず癌原発巣部における癌細胞の基底膜層の通過, 間質内での浸潤, その後に遭遇する脈管基底膜層の通過と脈管内への侵入, さらには転移としての着床部位における脈管外への遊出の際の脈管基底膜層の通過などが考えられ, 転移におけるいわゆるseed and soilの際に癌細胞が基底膜を何回にも渡って通過しなければならない.基底膜は主にIV型コラーゲンから構成されており, IV型コラーゲン分解酵素 (IVase) によって特異的に分解される.そこで癌組織中のIV ase活性はその癌の生物学的悪性度を表す指標となる可能性の追求を, まず組織中IV ase活性測定法を確立し, それを胃癌症例に用いて行い, その可能性を証明した.さらにIV型コラーゲンの分解産物である尿中3-hydroxyprolineが進行胃癌症例で増加していることもわかった.

Reflexion on the false positive cases of gastric endoscopic biopsy

From 1966 to 1970 we had 192 cases of gastric benign lesion, which are gastrectomized after the pathological evaluation using the endoscopic biopsy. In 188 cases (97.9 per cent), the pathological diagnosis of the biopsied materials was correct. In 4 cases (2.1 per cent), however, the pathological findings of that were overread incorrectly (False Positive). These four cases are all the depressed lesion and consist of three cases of benign gastric ulcers and one case.s of React ive Lymphoreticular Flyperplasia (RLH) . In the former, the errors were due to the atypical but benign regenerated epi thel ium and in the lat ter (RLH) , due to the Lympho id tissue which was miss diagnosed as the poorly differentiated carc inoma containing the signet r ing cell. They had t0 be rebiopsied, for they were all diagnosed as the benign lesion on the gastrocamera, and two cases of these were not the conclusively mal ignant on the pathological diagnosis of the biopsied materials. The correct pathological j udgemen t of the atypical regenerated epi thel ium is one of the most important but difficult subject and the fur ther evaluation should be necded. The decision of signet ring cell carc inoma on the biopsied materials requires the mucus staining me thod in addition to the usual I-hE. staining specimen in some eases. Besides, the contaminat ion of the biopsied materials should be cared for sufficiently.

Healing and recurring pattern of gastric ulcer observed with the microangiography of stomach

Clinical evaluation has been made in 30 patients with s tomach ulcer, 13 patients with duodenal ulcer and 3 patients with duodenal and gastric ulcer who were hospitalized between December 1968 and Augus t 1969. (1) Stomach ulcer is more at and around age 40, whereas duodenal ulcer is more at and around age 20. (2) The most of the pat ients with duodenal ulcer showed hyperacidity. (3) The duration of clinical symptomes is correlated well with the t ime necessary for heal ing s tomach ulcer.

Gastroscopic findings of the mucosal color tone and vascular architecture of the gastric wall

The so-called multiple gastric carcinoma simultaneously with more than two loci was relatively small in number. On 706 cases resected for gastric carcinoma in our clinic, 7 cases with two early cancer lesions and 17 cases with early cancer lesion associated with advanced cancer lesion in separate place were examined. Many of these cases showed IIa and IIc according to the endoscopical classification and occurred much more frequent ly on the lesser curvature of the lower and middle portion and also on the posterior wall of the stomach. The cases of more and less than 5cm in distance between both lesions were of the around same number. The early cancer together with advanced cancer was present on the cardiac side in 10 cases, while on the pyloric side in 7 cases. From the results of above-mentioned examination, we might s t ress the clinical importance of early gastric cancer in multiple gastr ic cancer with reference to that associated with advanced cancer, and the attention to avoid overlooking the focus in seperate portion by the accurate examination of the mucosa during operation.