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Primary small cell carcinoma of the esophagus, which is similar in appearance and behavior to its counterpart of the lung, is a rare tumor. We describe a 77 year-old woman whose esophagram revealed a well-defined mass in the lower third of the thoracic esophagus. A biopsy specimen showed an infiltration of small malignant cells. The individual cells were oval- or spindle-shaped with hyperchromatic nuclei and scant cytoplasm. Synaptophysin staining was positive. The mass was diagnosed as a small cell carcinoma of the esophagus. She underwent an esophagectomy with esophagogastric anastomosis. We discuss the treatment of small cell carcinoma of the esophagus.

Background/aims: Many authors have reported that Helicobacter pylori (H. pylori) is one of the major causes of gastritis and peptic ulcer. This study was conducted to evaluate the incidence of H. pylori infection and the curative effects of amoxicillin and omeprazole on H. pylori in the remnant stomach., Methodology: Biopsy specimens were obtained from 70 patients who underwent gastrectomy for gastric cancer. H. pylori was subsequently diagnosed by CLO test and culture of H. pylori. Gastritis was assessed by the scoring of four characteristic pathological parameters. Patients with positive H. pylori were eligible for the eradication study. Amoxicillin, 750 mg per day for 2 weeks, and omeprazole, 20 mg per day for 8 weeks, were administered to them. Endoscopic reexamination was performed 12 weeks after the initiation of treatment., Results: The overall positive rate of H. pylori was 37.1%; 39.6% in Billroth I reconstruction, 0% in Billroth II reconstruction, and 55.6% in pylorus preserving gastrectomy, respectively. The positive H. pylori rate of Billroth II reconstruction was significantly low. However, there was no association of positive rate of H. pylori with time. There was no significant difference of gastritis scores between H. pylori infected patients and non-infected patients. The eradication rate was 70.0%., Conclusions: H. pylori was present in 37.1% of patients who underwent gastrectomy. Gastritis was not significantly severe in H. pylori infected patients. The treatment with amoxicillin and omeprazole was effective for these patients.

Background/aims: One of the main problems in multimodal cancer treatment is the lack of prognostic parameters for the individual patient. This study was conducted to clarify the prognostic factors in patients with advanced colorectal cancer., Methodology: We examined DNA ploidy, Ki-67-derived growth fraction and the expression of CA 19-9, Sialyl Tn (STN) and carcinoembryonic antigens (CEA), along with standard clinicopathological variables including age, sex, tumor location, tumor size, cell differentiation, depth of invasion, and lymph node metastasis in 78 patients with advanced colorectal carcinoma, who underwent curative surgical resection. In addition, we determined the prognostic significance of these parameters., Results: Forty-six patients (59.0%) showed aneuploidy and 32 (41.0%) showed diploidy. The Ki-67 labeling index ranged from 13.9-40.3% with a mean of 24.9%. The index was not correlated with standard clinicopathological variables. There was no significant correlation between seropositive rates for CEA, CA 19-9, or STN and standard clinicopathological variables except for age. In tumor tissue, the positive rates for these antigens were 62.8% for CA 19-9, 67.1% for STN, and 96.2% for CEA. There was no significant correlation between positive rates and clinicopathological variables. The expression of STN in serum had the strongest association with survival, followed by lymph node metastasis and expression of STN in tissue., Conclusions: We conclude that not only lymph node metastasis but also STN expression are important prognostic factors in patients with advanced colorectal carcinoma who undergo curative surgical resection.

Background/aims: Our aim was to investigate clinicopathological characteristics of a medullary cancer infiltration with scanty stroma type (por1) and a diffuse cancer infiltration with scirrhous stroma type (por2) of poorly differentiated gastric adenocarcinoma, especially differences in lavage cytodiagnosis, lymph node metastasis pattern and nuclear DNA ploidy between them., Methodology: Age and gender of 168 patients (46: por1, 122: por2) and clinicopathological characteristics such as tumor site, lymph node metastasis, vascular invasion and serosal involvement were compared. Lymph node metastasis patterns were classified into 1) marginal, 2) nodular, 3) diffuse, and 4) massive types. The whole abdominal cavity was intra-operatively washed with 200 ml of saline, Papanicolaou-stained and used for lavage cytodiagnosis. Nuclear DNA ploidy pattern of carcinoma was determined using flow cytometry., Results: Lymph node metastasis rate was significantly higher in por2, especially in those with positive serosal invasion. Positive rate of lavage cytodiagnosis was significantly higher in por2 (38.9%), than that in por1 (9.1%). There were more hematogeneous recurrences in por1 more peritoneal disseminated recurrences in por2. Survival rate was better in por1., Conclusions: There were differences in lymph node metastasis, lavage cytodiagnosis and recurrence pattern between por1 and por2 even in poorly differentiated adenocarcinoma. These characteristics should be understood when selecting post-operative chemotherapy and also during follow-up.

We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.

This study was conducted to clarify the enhancement of the anti-tumor effect of CDDP by caffeine using a tumor-bearing peritoneal disseminated metastasis model in vivo. To evaluate the combined effect of CDDP and caffeine on the survival in vivo, nude mice bearing STKM-1 gastric cancer cells were administered CDDP alone, caffeine alone, or in both combination intraperitoneally. Treatment was started from 8 days after tumor inoculation. The combination of CDDP and caffeine more markedly prolonged the survival time than CDDP alone or caffeine alone. In conclusion, the results of the present in vivo study suggest that clinical application of caffeine in combination with CDDP might be effective against peritoneal disseminated metastasis in gastric cancer patients.

Background/aims: Close observation and evaluation of the function of the transposed stomach after esophagectomy is essential. The present study uses the sulfamethizole capsule meal test to evaluate differences in gastric emptying between the anterior and posterior mediastinal approaches in patients undergoing esophagectomy., Methodology: Thirty-eight patients who underwent the esophagectomy and esophagogastrostomy for esophageal cancer were randomly divided into 2 groups: Group 1: anterior mediastinal approach, and Group 2: posterior mediastinal approach. Gastric emptying was studied using the sulfamethizole capsule meal test. Patients received sulfamethizole food capsules, 65 g of bread, and 150 ml of water. Plasma sulfamethizole levels were determined by high performance liquid chromatography (HPLC)., Results: Gastric emptying in both groups was significantly accelerated compared to healthy volunteers. Gastric emptying did not differ significantly between groups 1 and 2., Conclusions: The present data show that the sulfamethizole capsule meal test is an effective means of evaluating the emptying of the transposed stomach. Furthermore, when the stomach is used as an esophageal substitute following esophagectomy, gastric emptying does not differ according to the access route.

Carcinosarcoma of the esophagus is a rare malignant tumor with both carcinomatous and sarcomatous components. We present 3 cases of carcinosarcoma of the esophagus and discuss the histogenesis of the tumors. We performed immunohistochemical studies using various antibodies: anti-cytokeratin, anti-vimentin, anti-smooth muscle actin, anti-p53, and MIB 1 reacting with Ki-67 nuclear antigen.

Background: Malnutrition, gallbladder dysfunction, dumping syndrome, reflux esophagitis, and gastritis of the remnant stomach are unfavorable sequelae in patients undergoing gastrectomy. Operative procedures should be improved to ensure such patients a satisfactory quality of life., Methods: After operation, gallbladder function, reflux gastritis, gastric emptying, and caloric intake were evaluated in 20 patients with early gastric cancer undergoing pylorus-preserving gastrectomy (PPG) and 25 patients undergoing conventional distal gastrectomy (CDG)., Results: The resting gallbladder area increased significantly after CDG. In contrast, after PPG the gallbladder area showed no significant change and the contraction rate decreased slightly. After CDG, emptying was much more rapid for the first 30 minutes after ingestion of a meal. Although delayed emptying was observed early after PPG, the rate of emptying increased with time. Gastric pH was lower and gastric mucosal injury was milder in patients undergoing PPG. These results are attributed to preserved pyloric function. The caloric intake and changes in body weight after operation were similar in both the CDG and PPG groups., Conclusions: PPG has advantages over CDG in terms of gallbladder function, the condition of the remnant stomach, and gastric emptying, PPG should be used in carefully selected patients with early gastric cancer to improve their quality of life.

A 71-year-old woman presented with an abdominal mass and ascites and was subsequently admitted to our hospital in June 1995. Further examination revealed that the mass was malignant and, as a result, surgery was indicated. However, the mass demonstrated widespread peritoneal dissemination, which therefore could not be resected, and pathological findings suggested a malignant peritoneal mesothelioma. The patient showed a remarkable response to combined chemotherapy with an accompanying intraperitoneal injection of cisplatin and etoposide and an intravenous injection of caffeine. However, owing to side effects, this regimen was discontinued. The patient was administered a combination drug of uracil and tegafur (UFT) in addition to intraperitoneal injection of cisplatin as an outpatient. By the 223rd day after surgery, the tumor mass and ascites had completely disappeared according to the CT. Hence chemotherapy was judged to have resulted in complete remission. Such a marked response to chemotherapy is rare in an advanced malignant peritoneal mesothelioma such as the present case. Eight months later, the tumor recurred in the pleura. Another regimen of chemotherapy with cisplatin and CPT-11 was performed. However, this treatment proved ineffective. The patient subsequently died of respiratory failure in January 1997 due to the mesothelioma. This is a case report of complete remission of malignant peritoneal mesothelioma by combined chemotherapy.

Background: The prognosis of gastric remnant cancer is considered to be poor compared with that of primary cancer., Materials and Methods: This study was conducted to elucidate the differences of clinicopathologic findings and treatment results between 59 patients with gastric remnant cancer (GRC) and 579 patients with primary proximal gastric cancer (PGC)., Results: There was no significant difference in the incidence of lymph node metastasis between GRC and PGC. However, changes in the metastatic pattern to lymph nodes were observed in GRC. In GRC, the tumor easily invaded the neighboring organs due to the adhesions around the remnant stomach, resulting in a low resectability with curative intent. The 5-year survival rate after curative resection for advanced GRC was 50.9%. GRC patients without serosal invasion had a good prognosis., Conclusion: Although the survival rate after curative resection for GRC patients was similar to that of PGC, GRC patients without serosal invasion had a better prognosis. Therefore, early detection is an important way to improve overall survival in GRC.

Through the use of STKM-1 human stomach cancer cells, we investigated the enhancement of the anti-tumor effect and the apoptosis induction of the CDDP and caffeine combination. Even when the concentration of CDDP was low, CDDP significantly decreased the proliferation of STKM-1 human stomach cancer cells, thus confirming the synergistic effect of the CDDP and caffeine group. The apoptotic labeling index of the CDDP plus caffeine combination was significantly higher than that of the CDDP group. In conclusion, caffeine enhanced the effect of CDDP by not only inhibiting DNA repairs but also inducing apoptosis.

It is well known that surgical intervention on the stomach will greatly alter gastric function and gastric emptying. In this study, we evaluated the difference in postoperative gastric remnant emptying following pylorus-preserving gastrectomy (PPG) and conventional subtotal gastrectomy (CDG) using sulfamethizole capsule food. The subjects comprised 18 patients who underwent PPG and 23 who underwent CDG for early gastric carcinoma. While delayed gastric emptying was observed early after PPG, 1 year after PPG it was markedly accelerated compared with that measured in the early postoperative period. However, it was slower than that in the CDG patients. On the other hand, rapid gastric emptying was observed early after CDG and did not change with time. These findings stress that although PPG results in stasis in the early postoperative period, it seems to prevent unduly rapid emptying.

The combination effect of 5-fluorouracil (5-FU) and cisplatin was examined in terms of the proliferation, morphology and expression of Ki-67 antigen, and propidium iodide (PI) staining using four cultured human gastric cancer cell lines, and we assessed how such activity was affected by the exposure time and the timing of treatment. MKN-1, MKN-28, MKN-45 and MKN-74 cells were exposed to various concentrations of 5-FU for 72 h and cisplatin for 8 or 72 h. At IC50, MKN-28 cells were more sensitive to 5-FU than other cell lines, whereas MKN-1 and MKN-45 cells were more sensitive to cisplatin than other cell lines. The cell growth-inhibitory activity of cisplatin was found to be 'area under the curve' dependent. When 5-FU and cisplatin were combined simultaneously, the combination effect was higher than that of 5-FU or cisplatin alone. On the other hand, when cisplatin was applied before 5-FU, there was no potentiation of the cell growth-inhibitory activity by combination treatment. In 5-FU-treated MKN-74 cells, the size, morphology and PI staining of nuclei were almost the same as those of the untreated cells, and the expression of Ki-67 antigen was less than that of the untreated cells. In cisplatin-treated MKN-74 cells, the size of cells and nuclei was larger than that of the untreated cells and fragmentation of nuclei was observed. The expression of Ki-67 antigen was less than the untreated cells but more than that of 5-FU-treated cells. In the cells treated with 5-FU and cisplatin in combination, the above changes were an intermediate of those of 5-FU-treated cells and cisplatin-treated cells. In conclusion, the cell growth-inhibitory activity of 5-FU and cisplatin against gastric cancer cells was potentiated by the combined treatment with 5-FU and cisplatin simultaneously, but not with cisplatin followed by 5-FU.

Expression and presence of the carbohydrate antigens CA19-9, SLX and STN, and CEA in tissues and serum were examined in 132 patients with early or propria muscle invaded gastric cancer. The seropositive rate was not different in patients with cancer or gastritis. In tumor tissue, the positive rate for these antigens was 28.8% in CA19-9, 9.1% in SLX, 47.0% in STN and 72.9% in CEA. Results showed that gastric cancers, even at an early stage, produce abnormal carbohydrate antigens not detected in normal tissues. However, transfer of antigens into the circulation was not observed in patients with early gastric cancer, suggesting the possibility that number of carcinoma cells may be involved in the transfer of antigens into blood.

Flow cytometric analysis of nuclear DNA ploidy was performed to evaluate the clinical significance of DNA-ploidy heterogeneity and DNA-index heterogeneity between the superficial layer and the deep layer of the tumor obtained from 88 advanced gastric cancer patients. DNA-ploidy heterogeneity was observed in 28 patients (31.8%) and characterized mainly by diploidy in the superficial layer and aneuploidy in the deep layer. More than 10% difference in the DNA index among aneuploidy (DNA-index heterogeneity) was observed in 10 (26.3%) of 38 patients with aneuploidy. There was no tendency for the DNA index to increase with deep infiltration. DNA-ploidy and DNA-index heterogeneities were not correlated with the various clinicopathological characteristics. Patients with aneuploidy had significantly poorer prognosis than did those with diploidy. The survival rate for patients with DNA heterogeneity was not significantly different from that for patients without DNA heterogeneity. These results suggest that the DNA-ploidy pattern may be an important prognostic factor, but that DNA heterogeneity may not have an impact on the survival in advanced gastric cancer.

We encountered a rare case of postbulbar ulcer caused by adjuvant chemotherapy after gastrectomy. A 64 year-old woman, who received chemotherapy with CDDP-5-FU after gastrectomy, developed severe hematemesis. Endoscopic examination revealed a gigantic ulcer at the anal site of Vater's papilla. The ulcer was healed with PPI and soft diet.

Depending upon the type of cancer involved, the period of the end stage varies greatly, and with it decreases the quality of life (QOL). In gastric cancer, for example, the terminal stage is usually short and the QOL diminishes abruptly. Thus, it takes time keeping this decrease in QOL to minimum, despite the complications, so that the patient's last days will be even somewhat more acceptable. Improvement in QOL for the patient who cannot eat due to recurrent gastric cancer can be effectively achieved by alleviation through IVH. With this in mind, the conditions consonant with the application of home IVH are as follows: 1) The patient's pain can be kept under control at home. 2) The patient wishes to remain. 3)There is sufficient human support at home. The caretakers in the family, and especially the key person(s) must exert much effort and labor and they need rest as well. Home medical care in the terminal stage presupposes a social environment involving day care, short stay, and hospice nursing facilities of all kinds. At present, public services of this kind differ with the community, much remains uninformed to public, and clinic-hospital networking will be needed more than ever. In this difficult situation, the home-care medical services provided by the private sector are effective. These services are only for the short term, of course, and there will be a financial problem. Various measures (tax deduction, public assistance) must be considered to support the patients and caretakers.

A 31-year-old woman was admitted to our hospital because of cervical and axillar lymph node swelling. A chest X-ray film showed many nodular shadows and a cavity in the left upper lung field. The tuberculin test was positive. Transbronchial lung biopsy and cervical lymph node biopsy were done. Examination of the biopsy specimens revealed epithelial granulomas with caseous necrosis. Thus, pulmonary tuberculosis with systemic lymph node swelling was diagnosed. Examinations during the patient's hospital stay showed that she was not an immunocompromised host. Pulmonary tuberculosis with systemic lymph node swelling occurs only rarely in a non-immunocompromised host.

This paper reports an extremely rare case of lymphoepithelial cyst of the pancreas. The patient, a 58-year-old man with no subjective symptoms, was found to have a pancreatic tumor during a physical examination. He visited our clinic and was admitted for a follow-up examination. Based on the ultrasonographic findings, superselective angiography, and aspiration biopsy, an epidermoid cyst was diagnosed. Enucleation was easily performed. Macroscopically, this cyst resembled an atheroma. Histologically, the cavity of the cyst was lined with a squamous epithelium with a nucleated layer and below that, lymphatic tissue. No malignancy was found. Tumors of the pancreas with a squamous epithelial covering are extremely rare; only a few such cases have been reported in the literature. As of 1991, only 12 cases, including the present case, had been reported. With the advances in diagnostic techniques, the detection of pancreatic tumors is expected to improve. This paper reports a case in which the use of an aspiration biopsy and superselective angiography proved to be useful in making an accurate diagnosis.

In order to improve the results of surgical treatment in advanced gastric cancer, we performed preoperative targeted chemotherapy for metastatic lymph nodes. The solution which contained aclarubicin adsorbed on activated carbon was submucously injected around gastric tumor under endoscopic observation 2-7 days prior to the operation. We termed this method medicinal lymph node dissection (MLD). Our standard surgical treatment (SST) for gastric cancer consists of gastrectomy and extended lymph node dissection (N1 and N2 lymph nodes). Patients of curative resection with histologically positive lymph node metastasis were enrolled, as the subjects. We compared the cumulative survival rate in 47 patients treated with SST+MLD (MLD group) with that in 125 patients treated with SST only (control group). Five year survival rates in the MLD and control groups were 60% and 48%, respectively. The MLD group showed significantly higher survival rate in patients with N3, N4 and infrapyloric lymph node metastasis. A significant difference of the survival rate suggests the efficacy of SST+MLD against micrometastasis in N3 and para-aortic lymph nodes. The SST+MLD therapy is recommended to the advanced gastric cancer, especially in the lower third of the stomach.

A study was conducted on 27 patients with cancer of the stomach who died from a postoperative recurrence of the cancer, 26 of whom died in the hospital and one of whom died at home. The period from the manifestation of initial symptoms of the recurrence to confirmed diagnosis was less than two months in 20 of the 26 cases (77%). The period from confirmed diagnosis to terminal hospitalization was in excess of three months in 11 of the 26 cases (42%). Of these cases, there were some in which it appeared that the time spent at home could have been extended through means such as another operation, insertion of an intraperitoneal access apparatus, or insertion of a subselective movable catheter. Forty-six percent (46%) of the patients were notified of their diagnosis, but none of them were notified of the recurrence of the cancer, suggesting the difficulty of notifying a patient of a diagnosis of cancer recurrence. A private home-care medical system was used in the case of the patient who had died at home of terminal stomach cancer. There were no major problems with this system other than the complaint that it placed a great financial burden on the family.

We performed combination chemotherapy consisting of 5-FU, leucovorin, and CDDP (FLP therapy) against noncurative resected or recurrent stomach cancer in outpatients as of August 1991. Seventeen outpatients patients underwent FLP therapy until February 1993. Therapeutic responses, survival time after the operation or recurrence, rate at home, and the improvement of performance status (PS) were studied. The response rate was 54.5%, median survival time was 410 days, the rate at home was 75.5 +/- 14.7%, and the rate of improvement of PS was 82.4%. Toxicities were observed in 70.6%. Thrombocytopenia must be followed carefully, but it was encountered in only a few patients. FLP therapy for advanced or recurrent stomach cancer in outpatients was expected to improve the QOL.

CDDP, 5-FU and LCV are administrated for recurrent gastric carcinoma in our hospital. We have been attempting translumbar local injection of a suspension of OK-432 and Lipiodol into the para-aortic lymph nodes or their surrounding areas for patients with para-aortic lymph node metastases when it was confirmed that the patient had a recurrence. This emulsion gradually degraded successively in the body. In this paper, we report the translumbar local injection method and its effective use in a case with para-aortic lymph node recurrence of gastric carcinoma.

We use CDDP and have compared the semiselective intraarterial infusion (ia group) with intravenous infusion (i.v. group) by measuring levels of the administered drug in blood and the abdominal organ tissues. In portal blood, the ia group showed a significant increase compared with the i.v. group. The patient tissue level was compared between the two groups. Higher levels were obtained in the peritoneum in the ia group. These results suggest that semiselective intraarterial infusion therapy is effective in peritoneal dissemination.

The patient was a 44-year-old male with gastric cancer accompanied by pancreatic invasion and metastasis to the periaortic lymph nodes. Combination chemotherapy with 5-FU, leucovorin (LCV) and CDDP (FLP therapy) was preoperatively given. Pancreaticoduodenectomy was carried out as absolutely noncurative resection. FLP therapy was continued postoperatively, and resulted in disappearance of the metastases in the periaortic lymph nodes on CT. As there were no findings of recurrence, the patient was regarded as being in complete response. In addition, the performance status improved from Grade 2 to Grade 0. Since the three-drug combination therapy induced only slight adverse reactions (Grades 1-2), it could be safely carried out at the outpatient department. Thus, combination therapy with 5-FU, LCV and CDDP is thought to be effective against gastric cancer.

The enhanced effect of CDDP combined with caffeine against P-388 leukemia was investigated. No synergistic effect was shown after one hour simultaneous treatment with CDDP and caffeine. But the growth inhibition was enhanced by the addition of caffeine after one hour treatment with CDDP. It is suggested that caffeine inhibits DNA repair by the reduction of CDDP-induced elongation of G2 + M phase. The increase in life span of mice after ip transplantation was observed by frequent ip injections of caffeine after CDDP injection. It is suggested that the effect of intraperitoneal administration of CDDP against peritoneal metastasis is enhanced by combination with caffeine.