Makoto Ichii

Values of carcinoembryonic antigen, elastase 1, and carbohydrate antigen determinant in aspirated pancreatic cystic fluid in the diagnosis of cysts of the pancreas

The levels of carcinoembryonic antigen (CEA), elastase 1, and carbohydrate antigen determinant (CA 19‐9) in the pancreatic cystic fluid and the serum from five patients with cystadenocarcinoma of the pancreas, one patient with retention cyst due to pancreatic carcinoma, three patients with cystadenoma, and eight patients with benign pseudocyst accompanying or following pancreatitis, were determined by immunoassay technique. Fluid from pancreatic cysts was obtained by ultrasonically‐guided percutaneous fine‐needle aspiration biopsy. The specimens were centrifuged and the supernatant was used for the measurement of CEA, elastase 1, and CA 19‐9, while the cell pellet was examined cytologically. The levels of CEA in the aspirated fluid were significantly higher in patients with malignant cysts of the pancreas than in those with benign cystadenomas and pseudocysts. In contrast, the levels of elastase 1 were significantly lower in patients with malignant cysts than in those with benign pancreatic cysts. Although the levels of CA 19‐9 were significantly higher in patients with malignant cysts than in those with pseudocysts, the overlap between the values of patients with malignant and benign pancreatic cysts is too great. The serum CA 19‐9 was most useful, however, to distinguish an individual patient with malignant cysts of the pancreas from those with benign pancreatic cyst, since there were no significant differences between the levels of serum CEA and elastase 1 in patients with malignant and benign pancreatic cysts. Correct diagnoses were made cytologically in 4 (66.7%) of 6 patients with malignant cysts. In two patients with malignant cyst, in whom no cancer cells were detectable in the aspirated materials, levels of CEA were abnormally high, but high levels of elastase 1 did not occur. Therefore, the combined measurement of CEA and elastase 1 in the aspirated cystic fluid of the pancreas could be used as an aid in diagnosis of malignant cysts of the pancreas.

Cooperative clinical trial of photodynamic therapy with photofrin II and excimer dye laser for early gastric cancer

Photodynamic therapy (PDT) is a recently developed endoscopic method for treating malignant tumors. For obtaining more photodynamic action with less thermal effect, we employed as the excitation light source for PDT an excimer dye laser, which is a pulsed laser with extremely high peak power, instead of an argon dye laser, which is a continuous wave laser and has been used conventionally.

Values of CA 19‐9 in the serum, pure pancreatic juice, and aspirated pancreatic material in the diagnosis of malignant pancreatic tumor

The diagnostic accuracy of the measurement of CA 19‐9 in the serum, pure pancreatic juice, and aspirated pancreatic fluid in the diagnosis of pancreatic tumors was assessed in 32 patients with malignant pancreatic tumors and 19 patients with pancreatitis. Pure pancreatic juice was collected from the pancreatic duct by endoscopic cannulation with a duodenofiberscope after intravenous administration of secretin. Pancreatic material was obtained by percutaneous fine‐needle aspiration biopsy under ultrasonic guidance. Abnormally high CA 19‐9 levels in the serum were significantly more frequent in patients with malignant pancreatic tumors than in those with pancreatitis: they were elevated in 71.9% of the patients with pancreatic tumors. High CA 19‐9 levels were found primarily in patients with a tumor of the head of the pancreas, in those with a tumor greater than 3 cm in its greatest diameter, and in those with an unresectable cancer. Only 57.1% of seven patients with a tumor of less than 3 cm in its greatest diameter showed an increase in CA 19‐9 level. The CA 19‐9 levels in pure pancreatic juice were significantly higher in patients with pancreatic tumors than in patients with pancreatitis without pancreatic stone. However, it was not useful for differentiating pancreatic tumors from pancreatitis with pancreatolithiasis. The CA 19‐9 level in pancreatic materials obtained by aspiration biopsy was significantly higher in patients with malignant pancreatic tumors than in those with pancreatitis. Eight patients (80%) with pancreatic tumors had values above 1000 U/ml, whereas all five patients with pancreatitis had values of less than 30 U/ml. Although CA 19‐9 levels in pancreatic materials was useful only when cytologic examination did not provide any evidence of malignancy, the combination of the CA 19‐9 assay and the cytologic study of specimens obtained by percutaneous fine‐needle aspiration biopsy of the pancreas increased the diagnostic rate to 100%.

Chromoendoscopic Observations on Extension and Development of Fundal Gastritis and Intestinal Metaplasia

The development and extension of fundal gastritis and intestinal metaplasia were investigated by the endoscopic Congo red-methylene blue test in 44 healthy subjects, 106 patients with gastric ulcer, and 26 patients with gastric polyp. Follow-up chromoendoscopic examinations were made an average of 3.4 yr (range 1-10 yr) after the initial endoscopic assessment. Fundal gastritis and intestinal metaplasia developed or became more extensive with time in only 3 (6.8%) and 2 (4.5%) healthy subjects, respectively. In patients with gastric ulcer and in those with gastric polyp, fundal gastritis and intestinal metaplasia developed or extended significantly more frequently and more rapidly than in healthy subjects. Fundal gastritis and intestinal metaplasia developed or became more extensive, respectively, in 26 (24.5%) and 23 (21.7%) patients with gastric ulcer and in 10 (38.5%) and 10 (38.5%) patients with gastric polyp. Fundal gastritis and intestinal metaplasia extended with time mainly in an upward direction.

Experimental and Clinical Studies on HPD-Photoradiation Therapy for Upper Gastrointestinal Cancer

There have been reports of the use of photosensitizing agents and conventional light source in experimental tumor destruction. In 1972, Diamonds et al. showed that hematoporphyrin was effective as a photosensitizing dye in treatment of animal tumor in vivo. In 1974, Tomson reported the use of acridine orange and aron laser in treatment of mouse epithelial tumors. Recently, Dougherty and Hayata reported success in the clinical treatment of human tumors by using hematoporphyrin derivative and dye laser. In the present paper, we first investigated the phototoxic effect of acridine orange (AO) and hematoporphyrin derivative (HPD) on implanted rat stomach tumor and then reported the clinical results of HPD-photoradiation therapy of the upper gastrointestinal cancers.

Destruction of implanted gastric tumors in rats by acridine orange photoactivation with an argon laser

The phototoxicity of acridine orange and argon laser irradiation on Walker carcinosarcoma 256 stomach tumors was studied. Wistar strain rats bearing stomach tumors 4-6 mm in diameter 5-10 days after their implantation were injected intraperitoneally with 40 mg/kg of acridine orange 2 hr before irradiation. Then the forestomach was opened and the tumors were exposed to the argon laser at 488 nm at an intensity of 15 mW/cm2 for 20 min. Tumors in rats treated with acridine orange were brightly fluorescent during irradiation. No marked temperature rise was detected during irradiation. Argon irradiation significantly prolonged the survival of rats treated with acridine orange. Histologically, complete or partial tumor necrosis was observed, with sparing of surrounding mucosa, in rats treated by the combination therapy. Phase-contrast and electron microscopy showed that cytotoxicity was mediated by changes in the cell, nuclear and lysosomal membranes. Neither the dye nor laser alone had any effect.

Carcinoembryonic Antigens in the Pericardial Fluid of Patients with Malignant Pericarditis

The diagnostic accuracy of measurement of carcinoembryonic antigen (CEA) and of analysis of the cytological characteristics of pericardial fluid was assessed in 10 patients with benign pericarditis and 7 patients with malignant pericarditis. The mean CEA levels of pericardial fluid specimens from patients with malignant pericarditis were significantly higher than those from patients with benign pericarditis. However, a high CEA level was not seen in a specimen of pericardial fluid which contained nonepithelial tumor cells. Positive cytological findings were obtained in specimens of pericardial fluid from 85.7% of the patients with malignant pericarditis. Correct diagnosis of malignancy was made by CEA assay alone or by cytological examination alone in 85.7% of the patients examined, while a combination of these methods raised the diagnostic rate to 100%.