Sumio Takayama

Effects of medical treatment on gastric mucosal abnormalities in gastroduodenal ulcer disease.

The development of carcinoma in cases of gastric ulcer disease during long-term H2-blocker treatment is slowly increasing, and ulcers that require such treatment exhibit the characteristics of intractable conditions, including linear ulcers, simultaneous gastric and duodenal ulcers, immature intestinal metaplasia of the gastric epithelium, and atrophic gastritis accompanied with multiple ulcer cicatrices. The incomplete form of intestinal metaplasia resembling Filipes type III lesions and showing structural atypia developed in the background gastric mucosa in such cases, and the characteristics of this metaplasia included structural atypia, a residuum of gastric-type mucous cells, rapid proliferative activity, and in some areas abnormal expression of P53 protein. In addition, in rat studies it was demonstrated that prolonged administration of H2-blockers while gastric ulcers were present accelerated cell proliferation in the background gastric mucosa in the long term. Accordingly, it was considered possible that the development of the incomplete form of intestinal metaplasia, which was strongly suggested to have some relation to the sites where intestinal-type gastric carcinoma appeared, was accelerated by mucosal injury due to chronic ulcers and by persistent elevation in intragastric pH. The results of the present study of gastric carcinoma as a complication of peptic ulcer disease indicated the possibility that Helicobacter pylori was a major contributory factor to the development of the incomplete form of intestinal metaplasia from damage to the background mucosa, but it was unclear whether H. pylori made any direct contribution to carcinogenesis.

Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

Direct percutaneous endoscopic duodenostomy: a case report.

A 78-year-old male, who had undergone left upper lobectomy because of traumatic pulmonary contusion at the age of 25 years, succumbed to left hemiplegia with impaired consciousness that was caused by right putaminal hemorrhage. Aspiration pneumonia was complicated and he was set on tracheostomy and tube feeding through a nasogastric tube. Although it was apparent that enteral nutrition through the percutaneous endoscopic gastrostomy was appropriate for him, performing a percutaneous endoscopic gastrostomy seemed impossible as the computed tomography revealed that the elevated stomach was located behind the heart. In this patient, we successfully performed a direct percutaneous endoscopic duodenostomy without any complication.

Neoadjuvant Chemotherapy (UFT· CDDP Therapy) for Borrmann 4 Type Gastric Carcinoma

We conducted neoadjuvant chemotherapy with CDDP-UFT for Borrmann 4 type gastric carcinoma and report here our findings on its usefulness. The study included an investigation of the association between measured DNA ploidy pattern and chemotherapeutic efficacy.We administered two three-week course of CDDP 100mg/m2 (day1) UFT400g/m2 (on consecutive days) preoperatively to 13 cases of Borrmann 4 type gastric carcinoma judged to be curatively unresectable. In addition, the DNA contents in the cancer tissue cell nuclei was mesured by flow cytometry before and after the chemotherapy. The response rate was 53.8%(7/13) and there was no difference found in therpeutic efficacy with difference in the DNA ploidy pattern. Ten cases were resectable. Cases exhibiting more marked histological efficacy were those an accumulation of S phase fraction among the diploid cases and thosewith a tendency toward flattening of the aneuploid peak among aneuploid cases.