Takao Sakita

Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis

Background: Various types of classification of gastritis have been proposed, but no plausible classification has been available until now. The Research Society for Gastritis performed a pilot study to establish an endoscopic classification, taking into consideration the following: (i) ease of use; (ii) permitting everyone the common image; and (iii) presence of histopathological evidence.

Randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma

SummaryWe performed a randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma between September 1979 and March 1983. A total of 309 patients were entered into this trial. Of the 309 patients, there were 98 evaluable patients in the chemotherapy group and 115 evaluable patients in the immunochemotherapy group. In both groups, Tegafur was given as chemotherapy at a daily dose of 400 to 800 mg, starting at 24–29 days after gastrectomy. In the immunochemotherapy group, 400 μg of N-CWS was injected i. d. within the 2nd postoperative week. It was given weekly during the first month and subsequently monthly for as long as practicable. The patients were surveyed for length of survival in March 1985. The postoperative survival rate was analyzed for all cases, and for patients with various histopathological stages of carcinoma for comparison between the two treatment groups. No statistical difference was detected between the two groups in terms of age, sex, surgical curabilities, or stage of carcinoma. The overall survival rate for all patients was significantly higher in the immunochemotherapy group than in the chemotherapy group (p<0.05). With stage III plus IV disease, 53 patients from the chemotherapy group and 61 patients from the immunochemotherapy group were included for the analysis. As a consequence, a highly significant survival rate was observed in patients with stage III plus IV carcinoma in the immunochemotherapy group (p<0.005) as compared to the chemotherapy group. The overall 5-year (1800 days) survival rate after surgical treatment was 60.2% for the chemotherapy group and 73.2% for the immunochemotherapy group. In patients with stage III plus IV disease, the 5-year survival rates of the two treatment groups were 28.8% and 52.4%, respectively. Accordingly, the 50% survival period of patients with stage III plus IV cancer was 1800 days or more in the immunochemotherapy group, whereas it was only 722 days in the chemotherapy group. These results emphasize the effectiveness of N-CWS as an adjuvant immunotherapeutic agent in postoperative gastric cancer patients.The main side effects of N-CWS were skin lesions in the injected sites and fever, but these were temporary and not serious.

A prospective study of endoscopic treatment for early gastric cancer in Japan: An interim report

Background: This prospective study was designed to clarify the present status and problems inherent in endoscopic treatment of early gastric cancer by endoscopic mucosal resection and other modalities in Japan and to investigate the possibility of extending the indications for endoscopic treatment.

Generation of T cell growth factor (TCGF)-dependent splenic lymphoid cell line with cell-mediated immunosuppressive reactivity against syngeneic murine tumor☆

Splenic T cells obtained from tumor-bearing mice could be cultured with T cell growth factor (TCGF) for over 12 months. The TCGF-dependent lymphoid cell line strongly inhibited cell-mediated anti-tumor immunity directed against syngeneic tumor. However, the suppression was non-specific for the given tumor. The cell line expanded with TCGF expressed a phenotypic characterization of T cells defined by monoclonal anti-Thy-1.2 antibody.

Leukocyte adherence inhibition microtest for the detection of cell-mediated immunity to tumor in gastric cancer patients.

The reactivities of leukocytes from gastric cancer and noncancer patients to gastric tumor and normal tissue extracts were tested by the leukocyte adherence inhibition (LAI) microtest, assessing cell-mediated immunoreactivity to adenocarcinoma of the stomach. The reactivities were expressed with the LAI index. All leukocyte preparations showed low reactivities, a LAI index of less than 20%, to normal tissue extracts and only the preparations of leukocytes from cancer patients displayed high reactivities, a LAI index of more than 20%, to tumor extracts. Assuming that a patient is sensitized to gastric tumor antigen if his leukocytes respond to at least one tumor extract with a LAI index of more than 20%, approximately half of the cancer tumor antigen. Thus, the LAI microtest appears to be a simple, rapid and specific method for demonstrating cell-mediated immunity to tumor.

Esophagofiberscope for screening

A new esophagofiberscope with wider angle of view field and smaller diameter was prepared for screening examinations. Using this new instrument in 459 subjects, 20 of 348 with reportedly normal x-ray examinations were found to harbor significant esophageal lesions. Among 111 cases diagnosed as abnormal by x-ray, 31 were found to be normal by use of the screening endoscope. Examination with the smaller instrument was appreciably more comfortable for the patients.

Abnormality of serum immunoglobulins in chronic liver disease-immune complex like substances, abnormaly basic γ-globulin, secretory IgA and anti-DNA antibody

1) Serum secretory IgA was reduced in chronic liver disease while it was increased in obstructive jaundice. 2) Serum anti-dsDNA antibody was slightly increased in chronic liver disease, especially it was significantly increased in lupoid hepatitis in which its titer paralelled with the course of disease activity. 3) Serum Clq binding activity, Clq binding inhibition activity and polyclonal rheumatoid factor binding inhibition activity were increased in chronic liver disease and their disease activity was correlated with concentration of macromolecular immune complexes which were fractionated with sucrose density gradient ultracentrifugation. 4) Abnormally basic y-globulin which was dominantly found in chronic hepatitis B sera was determined to be monomeric IgG. I t was increased in aggravation of the disease but has no correlation with Clq binding monomeric IgG. 5) Liver membrane specific lipoprotein (LP-1), Espinosas liver specific antigen (LSA), Nerenbergs hepatorenal antigen (HRA) and Tamm-Horsfall glycoprotein (THGP) had positive charge, and LP-2 and F-antigen did negative charge. 6) Human liver cell membrane fraction could not be obtained by the method of Ray or aqueous two phase polymer system which have been used for rat liver.

Polypoid lesion of stomach

Varix of the upper digestive truct is a sign seen in patient with the portal hypertension. According to Samuel 1) Nishiolka 2) and Yasumoto ~) gastric varices are detectable in advance of esophageal ones while the varix develops in the upper digestive truct as a sign of the portal hypertension. This report has been made on the basis of endoscopic examinations of the gastric varix in 30 patients with various disorders, including 16 liver cirrhosis, 7 chronic hepatitis, 1 primary hepatoma and 6 id!opathic portal hypertension. The simultaneous presence of the esophageal varix was seen in the Xray fihn in 17(56.7%) of these patients, while there was no correlation between the esophageal and gastric varices with reference to the degree of varix. The gastric varices detected endoscopically were classified into 4 morphological types as shown below. I) Winding type; winding vein dilatation in the submucosal layer, reaching the angle in a certain ease. This type was seen in 13 of 30 cases (43.30/0). 2) Nodular type; showing multiple nodular or polypoid lesions along with winding veins. This type was seen in 11 of 30 cases (36.6%). 3) Tumorous type; The X-ray film shows a tumorous shadow in the fornix, which is necessary to be differentiated from the carcinoma, and frequent increase in phrenico-fornix distance. This type was classified further into 2 subtypes; a) submucosal tumor type and b) polyp type, each of which was seen in 2 cases (6.7%), respectively. While the mucosal color of tumorous lesions was indistinguishable from the one of neighborhood in 3 of all 4 tumorous types, a case of the submucosal tumor type showed a vein-like bluish tinge on the surfacc. This difference in surface color tinge suggests that the former develops and enlarges predominantly in the subserosa layer and the latter in the submucosal layer. 4) Mixed type; the simultaneous presence of the above described various types. This type was seen in 2 cases(6.7%). In 17 of 30 patients with the gastric varix the examination revealed the simultaneous presence of the ulcer or the ulcer scar. The gastric varix is not so difficult to be diagnosed because of its characteristic morphology i examined with in mind.

On the study about the gastrocamera type PA with finder (GT-PF)

One of important factors of endoscopical examination of stomach is to observe every nook and corner of mueosa of the organ. Swan-type double-bending gastrofiberseope has been developed in order to facilitate observation of the parts which were difficult for usual gastrofiberscope. By bending the scope into swan-like shape, we can get front view of lesser curvature or posterior wall directly below cardia. We demonstrated an ulcer of posterior wall of corpus, part of beach of mucous lake, observed by reversing scope and inserting deeper. We gave examples of close observation of corpus of stomach, a case of cancer, scar of an ulcer, and fine gastric area. We also demonstrated erosions of pyloric part. Close observation of minute changes of this part was difficult for usual gastrofiberscope and actualized by swan-type gastrofiberscope.