Ryukichi Hada

Microvessel morphology and vascular endothelial growth factor expression in human colonic carcinoma with or without metastasis.

We quantified microvessel morphology and vascular endothelial growth factor (VEGF) expression in human colonic carcinoma with or without metastasis. The cancerous growth and the noncancerous section of surgical specimens from 36 patients with colorectal carcinoma (14 without metastasis and 22 with metastasis) were studied. Tissue slices immunostained with CD34 were processed for microvessel counts (per mm2), the mean diameter of microvessels (μm), and the mean spatial direction of microvessels (degree), defined by the angle between the longitudinal axis of microvessels and the direction perpendicular to the surface of the mucosa. Tissue slices immunostained with anti-VEGF antibody were processed for total epithelial cell counts (per mm2), VEGF-positive cell counts (per mm2), and VEGF-positive ratio (%). Carcinoma without metastasis had significantly larger microvessel counts (213 ± 77, p < 0.01), larger microvessel diameter (7.99 ± 1.77, p < 0.05), and larger spatial direction (47.2 ± 8.3, p < 0.01) than normal tissue (144 ± 49 for microvessel counts; 7.03 ± 0.90 for microvessel diameter; 39.5 ± 6.6 for spatial direction). Compared with carcinoma without metastasis, carcinoma with metastasis had a significantly larger microvessel diameter (9.75 ± 2.65, p < 0.03) and lower microvessel counts (180 ± 92, p = 0.51). Carcinoma without metastasis had a significantly larger VEGF-positive cell count (1276 ± 805, p < 0.05) and larger VEGF-positive ratio (53.6 ± 39.3, p < 0.05) than normal tissue (571 ± 553 for VEGF-positive cell counts; 24.6 ± 23.2 for VEGF-positive ratio). Carcinoma with metastasis had a significantly lower total cell count (1443 ± 237, p < 0.001) and lower VEGF-positive cell count (716 ± 463, p < 0.05) than carcinoma without metastasis. With tumor progression, microvessel diameter significantly increased and microvessel counts decreased, which can be in part explained by VEGF expression. The microvessel diameter seems to be the dominant parameter responsible for cancer cell intravasation as the first step of metastasis.

Survival and recurrence after low anterior resection and abdominoperineal resection for rectal cancer: the results of a long-term study with a review of the literature.

Morbidity, survival, and recurrence in 203 patients treated with curative low anterior resection (LAR) were compared with those in 100 patients treated with curative abdominoperineal resection (APR). The overall 5-year survival figures for the total number of, LAR and APR patients were 75.6±5.7%, 79.8±6.4% and 67.7±9.6%, respectively. The prognosis for cancers situated low enough in the rectum to involve the anal canal was poor even when managed by APR, as evidenced by a low survival at 5 years of 59.0±9.6% and a high pelvic recurrence rate of 34%. For all except these tumors, LAR proved at least equal to, or better than APR as a curative surgical method for middle and low rectal cancers, on the basis of 5-year survival being 79.8±6.4% vs 78.7±5.2%, operative mortality being 1.5% vs 1.0%, morbidity being 39.4% vs 59.0%, and the incidence of pelvic recurrence being 8.9% vs 13.5%. When deciding upon the most appropriate surgical procedure for rectal cancer, especially for middle or low rectal lesions, the patient should not simply be condemned to a permanent colostomy. Thus, we first attempt LAR for every lesion except those which are very advanced or those with anal canal involvement, if technically feasible and suitable for the individual patient.

Regurgitant bile acids and mucosal injury of the gastric remnant after partial gastrectomy

Three groups, each consisting of seven patients who had undergone either Billroth I, Billroth II, or pylorus-preserving gastrectomies, were evaluated more than 18 months postoperatively in terms of concentration and amount of bile acids in the gastric aspirate and histologic changes in the gastric remnant mucosa. Concentrations of bile acids were determined by gas chromatography and mucosal specimens were obtained by endoscopic biopsy. The total bile acid concentration and all of the individual fractional bile acid levels, whether free or conjugated, were significantly higher in the Billroth II group than in the other two groups. The amount of gastric aspirate was also highest in the Billroth II group. Endoscopic biopsy revealed glandular dysplasia to be predominantly in the Billroth II group. The presence of bile acids in the gastric remnant may contribute to mucosal injury, possibly leading to cancer in the gastric remnant, especially after the Billroth II operation.

Adenoma of the Nipple in an Adolescent

We recently treated a 14-year-old girl with a clinically and histologically diagnosed with adenoma of the nipple. Enucleation of a mass preserving the nipple was successfully performed. Adenoma of the nipple is a rare disease which is often mistaken clinically for Paget’s disease. About 200 cases of the tumors have been reported worldwide so far. The most common symptom is erosion of the nipple and nipple discharge. Our case had erosion of the nipple but no discharge. Adenoma of the nipple is a benign lesion which can be successfully treated by a simple surgery.

Carotid intima media thickness and aortic calcification index closely relate to cerebro- and cardiovascular disorders in hemodialysis patients

Aim:  Atherosclerosis can be evaluated by carotid intima media thickness (IMT), the aortic calcification index (ACI), and pulse wave velocity (PWV). We investigated which test was most closely related to cerebro‐ and cardiovascular disorders (CCVD) in hemodialysis patients.

ϱ-Shaped anastomosis: A reconstruction of the alimentary tract after total gastrectomy

Abstract One hundred sixty-four patients underwent total gastrectomy with a ϱ-shaped jejunal food pouch (ϱ loop) and Roux-en-Y jejunojejunostomy. The rate of postoperative complications was very low (9.1 per cent), and the most important problem of anastomotic failure was never encountered. Only 4 of 164 patients (2.4 per cent) died within one month of surgery, and the causes of death were pneumonia (2 patients), cerebral hemorrhage (1), and ileus (1). The function of the newly constructed passage was estimated through an elaborate barium meal examination. The test revealed that the ϱ-shaped jejunal food pouch has adequate reservoir and mixing functions for ingested foodstuff. No reflux of barium meal into the esophagus was observed during the examination. In a follow-up study of the patients, only a few complained of symptoms of reflux esophagitis or dumping, but none of them needed any treatment.

MORPHOMETRY FOR MICROVESSELS IN EARLY GASTRIC CANCER BY NARROW BAND IMAGING-EQUIPPED MAGNIFYING ENDOSCOPY

Background and Aim:  Microvascular architecture is a variable characterizing early gastric cancer (EGC) against the background. The aims of the present study were to measure morphological variables of the microvessels and to compare the variables between EGC and the background.

Difficulty in estimating localized bowel contraction by colonic manometry: a simultaneous recording of intraluminal pressure and luminal calibre

To examine whether or not intraluminal pressure changes at a site in the human colon reflect with fidelity the local bowel wall contractions or relaxation, endoscopic recording of the changes in colonic calibre as a parameter of the motor events with simultaneous manometry was performed at a fixed site in a prepared sigmoid colon during the interdigestive state. In four of the 12 subjects, a total of 20 phasic pressure waves with an amplitude of 13–22 mmHg and a duration of 13–18 sec were obtained in a 20 min recording session. Eighteen of the 20 phasic pressure waves (90%) were associated not with a decrease (contraction) but with an increase in the calibre (relaxation). The pressure change began 0.2–8.4 sec (mean: 4.5 sec) behind and ended − 1.8 to 8 sec (mean: 3.5 sec) ahead of the calibre change. In the other eight subjects, no phasic pressure change was recorded in the presence of an overt calibre change. We conclude that manometric phasic pressure change recorded at a site in the empty human colon is not necessarily correlated with the localized contractile activity. Extrapolation of pressure profiles in the colon to motor events at the manometric site should be cautious.

Vascular endothelial growth factor expression and microvessel parameters of colonic mucosa correlate with sensitivity to steroid in patients with ulcerative colitis

Objective Vascular endothelial growth factor (VEGF) expression and microvessel parameters have not yet been quantified in the colonic mucosa of ulcerative colitis (UC). The aim of this study was to correlate the parameters with clinical responsiveness to steroid therapy. Material and methods Colorectal biopsy specimens from 39 UC patients with high sensitivity to steroid (H-UC), 9 UC patients with low sensitivity to steroid (L-UC) and 6 normal controls (NC) were examined. Methods Tissue sections were immunostained with anti-VEGF antibody for number of inflammatory cells (/mm2), VEGF-positive cell (/mm2) and VEGF-positive ratio (%), and with CD34 for microvessel counts (/mm2) and the mean microvessel diameter (μm). Results The H-UC group had a significantly larger total cell count (10,048±2751, p<0.0001) or VEGF-positive cells (2363±707, p<0.0001) than the NC group (7235±2088 or 1537±297, respectively) with no difference in VEGF-positive ratio (24.3±6.9 for H-UC versus 22.7±6.9 for NC). The L-UC group had a significantly lower VEGF-positive cell count (1420±701, p<0.0005) or VEGF-positive ratio (11.6±5.5, p<0.0005) than the H-UC group, whereas microvessel counts were almost constant regardless of the subject groups (345±7 0 for NC versus 346±99 for H-UC versus 349±114 for L-UC). Significant increases in microvessel diameter were seen when comparing NC (6.68±0.60) with H-UC (7.83±1.09, p<0.0001) and H-UC with L-UC (9.05±1.70, p<0.03). Out of the five parameters, VEGF-positive ratio and microvessel diameter had a predictive value for L-UC with an 88.9% sensitivity and 88.9% specificity. Conclusions L-UC was characterized either as VEGF underexpression or enlarged microvessel. The disruption of the healing process or disturbance of microcirculation may be involved in low sensitivity to steroid therapy in UC.

Computer-aided grading system for endoscopic severity in patients with ulcerative colitis

The degree of mucosal redness can be quantified as an index of hemoglobin (IHB) that changes with photographic conditions. The first aim of the present study was to stress the exclusion of γ correction as a critical procedure for reliable measurements of IHB. The second aim was to characterize Matts grade by pictorial parameters in the gray scale picture of IHB and to establish a computer‐aided grading system of endoscopic severity in ulcerative colitis. A total of 130 digital endoscopic pictures of 55 patients with ulcerative colitis (30 Matts 1, 70 Matts 2, 20 Matts 3 and 10 Matts 4) were used. The pictures without γ correction were processed for the mean IHB, SD of IHB, kurtosis of IHB and contrast feature. A computer‐aided grading system was constructed on the basis of Bayes decision theory. Significant increase in the mean IHB was seen when comparing Matts 1 to Matts 2. The SD of IHB or contrast feature significantly increased from Matts 2 to Matts 3 or from Matts 3 to Matts 4. Kurtosis of IHB was significantly larger in Matts 3 than in Matts 1 or Matts 4. Sensitivity and specificity when discriminating Matts 1 from Matts 2, Matts 2 from Matts 3 and Matts 3 from Matts 4 by the grading system were found to be 84 and 96%, 94 and 70%, and 100 and 85%, respectively. The computer‐aided grading system may permit quantitative evaluation of effects of treatments in ulcerative colitis with minimal interobserver variation.