Sadamu Takano

No-touch isolation technique reduces intraoperative shedding of tumor cells into the portal vein during resection of colorectal cancer

BACKGROUND The mutant-allele-specific amplification (MASA) method is capable of detecting 1 genetically altered tumor cell among thousands of normal cells. The MASA enabled us to detect occult tumor cells undetectable by histopathologic examination of lymph nodes and blood samples. METHODS To investigate whether tumor manipulation during operation enhances cancer cell dissemination into the portal vein with use of MASA and to assess the effect of the no-touch isolation technique in the treatment of colorectal cancers, 27 colorectal cancers (17 were operated on conventionally and 10 were operated on according to the no-touch isolation technique) were screened for mutations in K-ras or p53. We next examined blood samples of the portal vein collected before, during, and after manipulation of tumors, using MASA to look for the specific mutation found in the primary tumors. RESULTS Somatic mutations were identified in 18 of these primary tumors (11 were in the conventional resection technique group and 7 were in the no-touch isolation technique group). In 8 of 11 (73%) conventional resection technique cases, we identified the same genetic alteration of the primary tumor in the portal blood during operation, whereas only 1 patient (14%) in the no-touch isolation technique group had a positive result. CONCLUSIONS The no-touch isolation technique may be useful to prevent cancer cells from being shed into the portal vein during surgical manipulation.

Zinc clearance correlates with clinical severity of Crohn's disease

After peroral and intravenous loading of zinc in 10 patients with Crohns disease, a kinetic analysis of serum zinc was carried out. The patients were divided into two groups depending on the clinical activity indices (group A: five with active form and group B: five with inactive form). The mean level of serum zinc was significantly reduced in group A patients, but not in group B, when compared to findings in control subjects. A significant reduction in AUCpo (area under the concentration vs time curve by peroral administration), accompanied by increased zinc clearance (ClZn) was also found in group A but not in group B. The ClZn significantly correlated with clinical activity indices. Absorption efficiency, the ratio of AUCpo/AUCiv (area under the concentration vs time curve by intravenous administration), was similar in group A, group B, and the control. Therefore, the absorption of zinc in patients with the disease seems to be intact, regardless of whether they have the active or inactive form of Crohns disease. The hypozincemia seen in patients with Crohns disease is presumably related to an accelerated turnover rather than to a malabsorption of zinc.

Antigen Reversion of Glycogen Phosphorylase Isoenzyme in Carcinoma and Proliferative Zone of Intestinal Metaplasia of the Human Stomach

Specific antibodies to three purified glycogen phosphorylase isoenzymes, i.e., brain (or fetal), muscle, and liver types, were used to study the localization of these isoenzymes in carcinoma and the proliferative zone of intestinal metaplasia of the human stomach. Both the malignant cells of well-differentiated adenocarcinoma and the proliferative zone of some intestinal metaplasia of the stomach were stained when the antibrain-type phosphorylase isoenzyme antibody was used, but not when the other two types were used. The results suggest that brain-type phosphorylase in gastric carcinoma could be one example of fetal protein expression in cancer, and that the proliferative zone of some intestinal metaplasia having brain-type phosphorylase may histogenetically relate to well-differentiated adenocarcinoma.

Evaluation of fibergastroscopic biopsy in the diagnosis of gastric cancer: A study of 339 cases

SummaryThree hundred and sixty-five biopsies under direct vision, using a fibergastroscope, were performed on 339 patients with gastric cancer from 1966 to 1975.Diagnostic accuracy improved with an increased in the number of biopsy specimens and reached 100% when 6 or more biopsy specimens were obtained.Positive specimens were obtained with 48.5% of the biopsied tissue from the center of the lesion (A), 52.2% from the inner margin of the lesion (B1), 19.6% from the outer margin of the lesion (B2), and 1.6% from the area around the lesion (C). The combined result of the biopsies from A and B1 was highly positive in 49 out of 51 cases (96.1%).Diagnostic accuracy of the early cancer reached 96.9%. This was significantly higher than that of advanced cancer (80.3%).False negative biopsies were found in 51 (16.3%) of the 313 patients who were gastrectomized and diagnosed by histological examinations. Twenty-three of the 27 patients, who were diagnosed as benign either by x-ray or endoscopie examination, and 4 of the 5 patients who were diagnosed as benign under both examinations, were found to have positive results by biopsy. Positive biopsy examination was particularly helpful with patients showing on inconclusive or benign diagnosis by x-ray and/or endoscopie examinations.

Primary hypertrophic pyloric stenosis in the adult

A case is reported of a 55 year old male patient with primary hypertrophic pyloric stenosis who was subjected to distal gastrectomy. Adult hypertrophic pyloric stenosis is an uncommon condition which is usually misdiagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal and endoscopically by appearances resembling those of the cervix. This condition is probably congenital although aetiology has not been established. In the absence of symptoms, no clinical treatment is required. However, surgical intervention is advocated, when stenosis gives rise to symptoms, there is a suspicion of malignancy, or the ulceration due to the disease. Distal gastrectomy with gastroduodenostomy is the treatment of choice.

Postoperative results of distal partial gastrectomy, selective vagotomy plus antrectomy, and selective proximal vagotomy for duodenal ulcers

We investigated the postperative results of distal partial gastrectomy, selective vagotomy plus antrectomy, and selective proximal vagotomy, to evaluate their effectiveness in the treatment of duodenal ulcers. The operative mortality of selective vagotomy plus antrectomy and selective proximal vagotomy seemed to be lower when compared to distal partial gastrectomy, although each procedure showed a sufficiently low mortality. The acid reduction rate was significantly lower after selective proximal vagotomy than after the other procedures (p<0.01). However, the rate of ulcer recurrence following selective proximal vagotomy tended to be higher compared with the other procedures. All three procedures showed good results according to Visick’s grading and postoperative symptoms occurred in about 50 per cent of all patients, no matter what the procedure. The regaining of physical ability was significantly greater following selective proximal vagotomy than following distal partial gastrectomy (p<0.05) and the capacity to work was also better after vagotomy, particularly selective vagotomy plus antrectomy (p<0.05). Thus, although distal partial gastrectomy and selective vagotomy plus antrectomy proved superior regarding the low ulcer recurrence rate and acid reduction, while selective proximal vagotomy proved superior for improving the quality of life, on the whole the three operations promise almost equivalent results.

Solitary ulcer of the rectum: report of a case and review of the literature

SummaryA 13-year-old girl with Prader-Willi syndrome was admitted to our hospital with an 18-month history of anal bleeding and mucus discharge on defecation.Physical examination revealed obesity, hypogonadism, hypotonia and hypomentia. On digital examination, a nodular mass was palpated on the right wall of the amupulla recti, which was suspected to be carcinoma on a barium enema study. Proctoscopic examination revealed a large, irregular ulceration with white slough at the base, surrounded by the nodular and lumpy mucosa.The lesion was excised by the abdomino-anal pull-through method. The resected specimen showed a lesion of large, shallow, irregular ulcer, 5.0 x 2.2 cm in size. Microscopic examination revealed obliterated lamina propria by fibroblasts and muscle fibers derived from the muscularis mucosae, and misplaced cystic dilated glands in the submucosa at the margin of the ulcer. The gross and microscopic appearances are identical to those of “solitary ulcer of the rectum” described by Madigan and others, and similar to those of “colitis cystica profunda” described by Goodall and others. According to these findings, this lesion was diagnosed as solitary ulcer of the rectum.In the present report, the relationship between solitary ulcer of the rectum and colitis cystica profunda was discussed.

Intranuclear synthesized and native glycogen particles in human gastric cancer: ultrastructure and histochemistry.

SummaryUltrastructural and histochemical studies on human gastric cancer cells disclosed the presence of native and synthesized glycogen particles. The glycogen particles were investigated in the histochemical synthesis of glycogen particles from glucose 1-phosphate by the phosphorylase-branching glycosyltransferase system and non-incubated native glycogen in human gastric adenocarcinoma tubulare.It was observed that focal synthesis localized in the intracytoplasmic matrix and intranucleus. Intranuclear synthesized glycogen appeared as a rosette form ranging from 1100 to 1300 Å in diameter and free particles ranging from 325 to 900 Å in diameter. The synthesis of glycogen appeared in the nucleus as well as in the cytoplasm of the human gastric cancer cells, and the synthesized glycogen was observed as a group of particles. Newly formed glycogen particles appeared occasionally in the interchromatin area as a large macromolecular structure of rosette form.Native glycogen appeared as a free-particle (250–333 Å, medium=300 Å) and aggregated rosette from (694–1050 Å, medium=917 Å) in the autophagosome of gastric cancer cells. There was not, however, a native glycogen particle in the nuclei of gastric cancer cells.Under certain conditions the nuclei of gastric cancer cells can acquire the capacity to synthesize glycogen.

Reduction of estrogen and prolactin receptors in 7,12-dimethylbenz(a)anthracene-induced rat mammary tumor by high doses of estrogen

Daily injections of 100 μg17 β-estradiol, or 250 μg tamoxifen, for 10 days led to a regression of the 7,12-dimenthylbenz(a)anthracene (DMBA)-induced rat mammary tumor. Estrogen receptor (ER), progesterone receptor (PgR), and prolactin receptor (PRL-R) in the regressed tumor were significantly reduced in the estrogen-treated rats. ER and PRL-R were low but PgR increased significantly in the tumor of the tamoxifen-treated rats. A single administration of 100 μg estradiol induced a transient decrease of ER and PRL-R, and an increase of PgR, in the DMBA-tumor. Similar decreases in ER and PRL-R and the increase of PgR were observed 8 hours after the 5th injection of 100 μg estradiol—a time when the tumor had already regressed. These results suggest that high dose-estrogen has a direct inhibitory effect on the concentration of both ER and PRL-R in the DMBA-tumor, and that this effect might be accumulative with repeated administrations. It is unlikely that the inhibition of the estrogenic effect caused by loss of ER is the sole mechanism of the regression of the DMBA-tumor, since the increased synthesis of PgR as a marker of estrogen action was observed even after the ER-reduction and tumor-regression.

Hyperglycemia induces intestinal sucrase activity in subtotally pancreatectomized rats

SummaryThe effects of experimental diabetes, hypertonic glucose infusion, and subsequent insulin administration on the sucrase activity of the small intestine were studied using intestinal segments completely excluded from luminal continuity by construction of Thiry-Vella fistulas in rats. Eight weeks after subtotal pancreatectomy, the rats contracted insulin-deficient diabetes mellitus, and sucrase activity was enhanced in both the Thiry-Vella loop and in the proximal jejunum in continuity. Subcutaneous injections of insulin during the last 4 weeks maintained the enzyme activity in the control range in both segments. There was a positive correlation between sucrase activity and blood glucose level in the pancreatectomized rats. Hyperglycemia in normal rats induced by intravenous infusion of 30% glucose solution over 48 hours enhanced the sucrase activity in the jejunum. Furthermore, insulin administration with a glucose solution inhibited the enhancement of enzyme activity. These findings suggest that hyperglycemia itself might play an important role in the diabetic increment of sucrase activity.