Masakatsu Sunagawa

Prognostic factors of early gastric cancer —Results of long-term follow-up and analysis of recurrent cases—

The prognosis of early gastric cancer (EGC) is generally excellent, however, EGC is not an exception to recurrence. In order to know what type of EGC is liable to recur, long-term results were studied in 304 cases of resection. The cumulative 10-year survival rate was poorer in patients with positive lymph nodes than in those with negative nodes (52.8±15.8 per centvs 94.1±2.4 per cent; p<0.05). It was also less favorable when the EGC was greater than 5 cm in diameter (61.5±13.2 per centvs 92.9±2.4 per cent;p<0.05). Among 50 cases which died postoperatively, six deaths were due to recurrence. A predominant mode of recurrence was hematogenous metastasis (4/6). The characteristics of EGC which recurred later included large cancer (≧5 cm) (6/6), macroscopically combined-type cancer (5/6), cancer of depth invasion to the submucosa (4/6) and histologically differentiated cancer (6/6). Lymph node dissection was not carried out in two of these patients at their primary operation. Adjuvant therapy should be added in the EGC bearing risk factors depicted above. Primary cancer in other organs, either metachronous or synchronous, was found in 13 cases (4.3 per cent). Colonic cancer, in particular, was seen in three, and it was 4.8 times as frequent as the expected number of the general population, calculated using the person-year method.

Effect of lentinan on lymphocyte subsets of peripheral blood, lymph nodes, and tumor tissues in patients with gastric cancer.

The effect of lentinan on lymphocyte subsets of peripheral blood, lymph nodes, and tumor tissues in gastric cancer patients was investigated. A 2-mg dose of lentinan was administered to 12 patients intravenously twice, the first at 3–9 days before and the second the day before surgery. The results were then compared with a control group without lentinan administration comprising 12 patients. Regarding peripheral blood and lymph nodes without metastasis, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu7, and anti-Leu11 were analyzed by flowcytometry. As for tumor tissues, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu11, and anti-M3 were analyzed after immunohistochemical staining. There were no significant changes in the lymphocyte subsets of peripheral blood between the two groups. In the lymph nodes, the CD4 cell ratios increased; otherwise in regard to tumor-infiltrating lymphocytes (TILs), the number of CD4, Leu11 and LeuM3 cells showed a prominent increase. Therefore, lentinan was observed to produce different effects in accordance with the subjective organs.

Endoscopic evaluation of gastric cancer infiltrating the lower esophagus

SummaryEndoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoseopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoseopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.

Recurrent Gastric Cancer after Absolute Curative Resection

Among 428 patients who had undergone absolute curative resection of gastric cancer, 57 died of cancer recurrence. One hundred and seventeen patients who had survived longer than 5 years were used as c

Sequential changes in nuclear dna content by chemotherapy observed in experimental canine gastric cancer

SummaryIt is known that the nuclear DNA contents correlate with the grade of malignancy. In this study, nuclear DNA contents of biopsy specimens taken from N-ethyl-N′-nitro-N-nitrosoguanidine (ENNG)-induced canine gastric cancer were measured by Feulgen-DNA-cytofluorometry. The DNA content and histological findings were sequentially observed after weekly administration of 7-N-(p-hydroxyphenyl)-mitomycin C (0.8 mg/kg), a kind of mitomycin C derivative. The appearance rate of cells over 4C decreased remarkably from 18.8% to 9.86% on average (p< 0.02) and the maximum value of distribution also went down from 9.18C to 7.33C (p< 0.01) at the early stage of administration of the oncostatic agent when no histological change was yet observable. It might be expected that this procedure will enable the future evaluation of oncostatic effects at the cellular level more objectively.

The distribution of serotonin-containing cells in the human alimentary tract

SummaryThe distribution of serotonin-containing cells (SC cells) in the human alimentary tract was studied by means of the fluorescent histochemical method of Falck et al. on surgically resected specimens. No SC cells could be observed in the nonmucosal parts of the alimentary tract and in the squamous cell epithelium of the esophagus.The richest SC cells were observed in the upper portion of the small intestine (namely the duodenum and the jejunum). The rectum was relatively rich in the distribution of SC cells. They moderately distributed in the terminal ileum and the pyloric and cardiac gland region of the stomach. The ascending, transverse, descending and sigmoid colon and the fundic gland region of the stomach showed poor distribution of SC cells.The basal-layer of the mucosa contained generally richer SC cells than the superficial-layer of the mucosa throughout the alimentary tract except for the esophagus. In the pyloric gland region of the stomach, the rectum and the upper portin of the small intestine, often a few SC cells were observed in the basal part of several glands in the transverse section. In contrast, SC cells could be rarely identified in other parts of the alimentary tract even in the basal part of the mucosa. And it was characteristic that SC cells distributed fairly even in the mucosa of the sigmoid colon.

Basic studies of photodynamic therapy in experimentally induced canine gastric cancer

Photodynamic therapy (PDT) was used in two cases of experimental canine gastric cancer produced by the oral administration ofN-ethyl-N′-nitro-N-nitrosoguanidine (ENNG). Endoscopic examination and biospy showed the development of cancer in the gastric antrum. The cancerous lesions, a polypoid lesion and the normal epithelium were photoradiated superficially by an argon dye laser with a power of 300 to 400 mW for five to ten 30-s periods, 48 h after the intravenous injection of 3.0 mg/kg body weight of haematoporphyrin derivative (HPD). Dog 1 was killed three days after PDT, and was examined histologically. The tumour cells showed vacuolar degenerative changes in the mucosa, and the irradiated normal epithelium was less damaged. Dog 2 was followed up periodically by means of gastrofibrescope and biopsy. A wider and deeper ulcerative lesion was observed three days after PDT and it was healed by day 40. But the recurrence of a cancerous lesion was shown on day 80. The remnant of a small cancer nest was revealed histologically by means of biopsy and autopsy. The results show that PDT is suitable for superficial gastric cancer and that long-term follow-up observation is necessary for the evaluation of PDT.

Modified radical mastectomy with preservation of the pectoralis major muscle.

A new technique of modified radical mastectomy for early breast cancer was devised with an express purpose of preserving pectoralis major muscle but still enabling radical removal of the regional lymphnodes. the pectoralis major muscle was transected at its midportion to expose the thoracic wall for radical dissection of axillar and subclavicular lymphnodes followed by resuturing of the muscle to preserve its continuity. The parasternal nodes can also be dissected if necessary. The pectoralis minor muscle is either resected or preserved. This procedure should be applied mainly in T1N0 and T1N1a (Stage I in the TNM staging system) which seems recently to be increasing rapidly in number and for which the radical mastectomy with resection of pectoralis major muscle is thought to be too excessive.The procedure proposed in the present communication offers advantage not only in functional but also cosmetic aspect by preserving the pectoralis major muscle while the radicality of the oepration is retained. Although the number of cases thus treated is limited and the long-term follow up with survival rate is not yet available, the procedure seems to be of considerable value in selected patients.

Selective depletion of serotonin in the alimentary tract of rats with p-chlorophenylalanine treatment, and the effect of serotonin depletion on its movements and on the response to biogenic amines

SummarySerotonin (5-HT) and histamine levels in three different status-control, p-chlorophenylalanine-(PCPA)-treated and fasting rats—were determined by the spectrophotoflrometric assay throughout the gut. Then, the esophagus, duodenum, jujenum, ileum and colon from PCPA-treated rats were investigated for their motilities and responses to biogenic amines and their antagonists by means of Magnus’ method.Seventy-four percent to 86% averaging 79% reduction of 5-HT content throughout the alimentary tract was obtained by daily administrations of 200 mg/kg of PCPA for 4 days, although no reduction was observed in histamine content. Little effect in 5-HT and histamine levels was observed by fasting for 48 hr.Species difference between rat and guinea pig was prominent in 5-HT content in the small intestine and in sensitivity to PCPA treatment.Isolated preparations from all parts of the gut from PCPA-treated rats showed the marked elevation of the tonus in the response to 5-HT in vitro.Histamine induced the contraction of the small intestine and the relaxation of the colon, and these effects were not inhibited by histamine H2-receptor blocker, burimamide.