Kikuo Nagashima

Expression of Ets-1 angiogenesis-related protein in gastric cancer

The Ets-1 transcription factor plays important roles in invasiveness and angiogenesis. Using automated immunodetection, we investigated Ets-1 expression and tumor microvessel density (MVD) in relation to the clinical significance of gastric cancer. The MVD of Ets-1-positive tumors was higher than that of Ets-1-negative tumors, but the difference was insignificant. The survival rate of patients with high-MVD tumors was significantly poorer than those with low-MVD tumors, and the survival rate of patients with Ets-1-positive tumors was significantly poorer than that of those with negative ones. These results indicate that Ets-1 expression is a useful marker for predicting the outcome for patients with gastric cancer.

Surgical treatment of neuroblastomas in infants under 12 months of age

BACKGROUND Surgical treatment of neuroblastomas, both those detected by screening and those detected clinically, in infants less than 12 months of age, is controversial, because some tumors in this age group potentially have the ability to regress spontaneously. METHODS From January 1985 to March 1997, the authors treated 50 infants (under 1 year of age) with neuroblastoma: 23 boys and 27 girls. Forty-one cases were detected preclinically by screening when the patients were 6 to 11 months of age (median, 7 months), and nine patients were discovered to have clinical manifestations at the age of 1 to 10 months (median, 4 months). RESULTS The tumor was INSS stage 3 or 4 in 10 patients (24%) with screening-detected tumor and in five (56%) with clinically detected tumor, although the difference was not statistically significant. Four screening-positive patients had multifocal primary tumors, and three of them were synchronous bilateral adrenal neuroblastomas. There was no statistically significant difference between the screening-detected tumors and the clinically detected tumors in biological characteristics such as Shimadas histology, DNA ploidy, and N-myc amplification. Complete resection of the primary lesion was accomplished by either primary surgery or second look (delayed primary) surgery in 46 patients (92%), and the resection was incomplete in the remaining four. In patients with bilateral adrenal tumors, the larger one was primarily resected, and the smaller contralateral tumor was enucleated or resected by partial adrenalectomy. Surgical complications included postoperative adhesive ileus (n=2), Horners syndrome (n=2), renal atrophy (n=1), renal failure (n=1), phrenic nerve injury (n=1), chylous ascites (n=1), chylothorax (n=1) and intussusception (n=1). One patient died of respiratory failure caused by a complication, but 49 patients (98%) were alive at the time of evaluation. CONCLUSION When considering surgical treatment of infants with biologically favorable neuroblastoma, the risk involved in treatment should be weighed against the risk inherent in a tumor capable of spontaneous regression, and aggressive surgery is unacceptable.

Hypercalcemia associated with osteolytic lesions in the extramedullary blastic crisis of chronic myelogenous leukemia: Report of a case

SummaryA 43-year-old male patient with hypercalcemia and osteolytic lesions complicating chronic myelogenous leukemia is presented. Extramedullary myeloid blastic crisis was diagnosed by the histological finding of the specimen biopsied from a osteolytic lesion in the right femur. As the serum levels of parathyroid hormone, 1,25 (OH)2 vitamin D, prostaglandin E2 and interleukin 1, and the urinary excretion of cyclic AMP were all normal, it was considered that the hypercalcemia was attributed to the bone destruction by the invasion of leukemic myeloblasts.

Cystic duplication of the cecum lined by dermal type squamous epithelium

This is a case report of a cystic duplication of the cecum in a 6-month-old female infant, which was lined by both columnar and squamous epithelium. This squamous epithelium did not resemble esophageal epithelium but dermal epithelium. The so-called split notochord theory can explain the possibility of the coexistence of ectoderm and entoderm components. However, the present case had no vertebral abnormalities.

Idiopathic Omental Bleeding: Report of a Case

We report a case of idiopathic omental bleeding in a 27-year-old man who was brought to our hospital after the sudden development of intermittent abdominal pain, nausea, and fainting. Computed tomography showed intra-abdominal fluid and emergency laparotomy revealed a hemorrhagic mass in the omental bursa, which was excised. The patient was successfully treated and a diagnosis of idiopathic omental bleeding was made.

Treatment of a stage I testicular yolk sac tumor with vascular invasion.

There is controversy concerning the treatment of stage I yolk sac tumor of the testis, particularly of those with histological factors that indicate a high risk of relapse. Usually orchiectomy alone is sufficient and adjuvant chemotherapy is unnecessary. Retroperitoneal lymphadenectomy is indicated for patients with persistently high alpha‐fetoprotein. Once recurred, treatment at that time is thought to be curative. However, postoperative chemotherapy may be necessary for patients with a tumor expressing histological factors that predict possible relapse. In this paper we report on a case of a 2 year old boy whose tumor invaded the testicular veins. The patient suffered from recurrent disease but was successfully treated by chemotherapeutic regimens including cisplatin and retroperitoneal lymphadenectomy. The importance of the histological factors in making a decision on the treatment strategy for stage I testicular yolk sac tumor is discussed.

Retrospective analysis of biological factors in a recurrent IV-S neuroblastoma with intermediate-grade malignancy

A clinical stage of IV-S neuroblastoma is known to include heterogeneous tumors. The authors report a case of IV-S neuroblastoma that relapsed after regression 4 years and 10 months after diagnosis. Multiagent chemotherapy was necessary to control the disease, and the patient has been doing well with no evidence of disease for more than 5 years. Although Shimadas classification showed favorable characteristics, N-myc protein was positive and DNA ploidy was diploidy in the tumor at diagnosis. Discrepancy in DNA ploidy was observed and aneuploidy was shown in tumor specimens at recurrence. Experience in this case showed the following important clinical features: (1) IV-S neuroblastoma of intermediate-grade malignancy does exist, and patients with such a disease may be cured by aggressive treatment; (2) Identifying IV-S patients with an unfavorable clinical course is possible by examining biological prognostic factors.

Laparoscopic Gastropexy by Abdominal Wall-Lifting Procedure for Acute Gastric Volvulus

We report on a 6-year-old girl with acute gastric volvulus treated successfully with laparoscopic anterior gastropexy by the abdominal wall-lifting technique. The gastrocolic ligament was poorly developed, which allowed mesenterioaxial volvulus. Anterior gastropexy was easily accomplished by direct suturing with extracorporeal knotting under normal pressure. This procedure, which produces a working space sufficient for the gastropexy, is simple, safe, and cost beneficial because there is no requirement for pneumoperitoneum. This experience impressed on us that an intraoperative upper gastrointestinal series should be used to help the surgeon fix the stomach in its anatomically correct position.

Usefulness of Introducer Technique Combined with a Commercially Available Anchoring Device for Percutaneous Endoscopic Gastrostomy

Background and Purpose: The pull or push technique for percutaneous endoscopic gastrostomy (PEG) placement has some disadvantages. We have safely performed PEG with the introducer technique using an anchoring device that secures the stomach to the abdominal wall. Patients and Methods: Two patients with neurologic impairment and one with lockjaw underwent PEG with the introducer technique because of feeding difficulties. In the former patients, retroflexion of the neck developed excessively, and periodic changing of the feeding tube was hard to perform. With the patient under general anesthesia, two fixing sutures for gastropexy were placed 2 cm apart using the anchoring device. Between the fixing sutures, a puncture needle with a peel-away sheath was passed into the stomach, and a 13F Silastic catheter was passed through the sheath. The catheter was secured after a balloon was inflated. Feeding was started 24 hours after the catheter insertion. Results: The operative times for the various cases were 42, 6...