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BACKGROUND: Despite the widespread use of endoscopic mucosal resection (EMR) for intramucosal gastric carcinoma, there is no standardized therapy for those patients in whom the carcinoma is found, after EMR, to have invaded the submucosa.Our aim in this study was to examine the relationship between the clinicopathological features of submucosal invasive carcinomas and their incidence of nodal micrometastasis, as detected by anti-human cytokeratin immunohistochemistry, in order to assess the curative potential of submucosal carcinoma by EMR.METHODS: Fifty surgically resected submucosal gastric carcinomas which would have satisfied the absolute indications for EMR, except for the criterion of submucosal invasion, were examined. The extent of submucosal invasion was determined by measuring its vertical and horizontal spread. Immunohistochemical analysis was performed with anti-human cytokeratin antibody (CAM5.2).RESULTS: Three of 50 cases (6.0%) were positive for nodal metastasis by routine H&E examination. Nodal micrometastases were detected in 11 of 47 cases (23.4%). Statistical analysis revealed that both the depth and the width of carcinoma in the submucosa were significantly larger in cases with than in those without micrometastasis ( P = 0.019 and P = 0.006, respectively). The group with lymphatic invasion showed more frequent micrometastasis than the group without ( P = 0.014). There were no micrometastases in submucosal carcinomas whose submucosal invasion was less than 200 &mgr;m vertically and less than 320 &mgr;m horizontally.CONCLUSIONS: The present study indicates that differentiated gastric adenocarcinoma with minimal submucosal invasion (less than 200 &mgr;m vertically and less than 320 &mgr;m horizontally) and not accompanied by peptic ulcer or other risk factors, such as lymphatic invasion, can be considered as having high curative potential by EMR alone, without the necessity for further radical surgery.

Background: Miconazole is an antimycotic agent with bacteriocidal activity against Helicobacter pylori in vitro. Its role in the clinical eradication of H. pylori has not been studied. The objective of this study was to investigate the efficacy and side effect profile of miconazole for the treatment of H. pylori., Materials and Methods: We studied 65 patients with gastritis or peptic ulcer disease in whom H. pylori infection was confirmed by a rapid urease test and microbiologic assessment. In vitro miconazole sensitivity was assessed for the H. pylori strains isolated from the enrolled patients. All patients were randomized to receive either dual therapy consisting of lansoprazole 30 mg daily and amoxicillin 500 mg three times a day for 14 days (LA, n = 33) or triple therapy using the LA regimen plus miconazole gel 100 mg three times a day for 14 days (LAM, n = 32). At least 8 weeks after the treatment, successful therapy was validated by the histological and microbiologic assessment. Adverse effects and drug adherence were monitored by direct questioning., Results: The minimum inhibitory concentrations of miconazole ranged from 3.13 to 6.25 mg/L. H. pylori was eradicated in 16 of 33 patients (48%, 95% CI = 31% to 67%) after LA therapy, and 24 of 32 patients (75%, 95% CI = 59% to 91%) after LAM therapy (p < .03). There was no significant difference in the occurrence of adverse events between the two groups., Conclusions: The addition of miconazole gel to the LA regimen significantly improved the cure rate of H. pylori without an increase in adverse effects.

A cooperative clinical study of photodynamic therapy (PDT) for superficial esophageal carcinoma was conducted at 6 medical institution. PHE (2mg/kg) with high tumor affinity was used as the oncotropic compound. The light source was a pulse wave YAG-OPO laser with high penetration into the tissue. Irradiation was performed at an energy density of 60-180 J/cm(2) 48-72 h after PHE administration. Eight lesions in 6 patients were treated. All were type 0-II superficial carcinomas. The depth of invasion was EP-MM for 6 lesions and SM for 2 lesions. A complete response (CR) was achieved in all patients after one session of PDT. Five adverse events, including anemia and fever, were reported by 4 patients, but all were WHO grade 2 or lower and transient. PDT using PHE and YAG-OPO laser was therefore considered effective as a curative therapy for superficial esophageal carcinoma.

Background and Objective: Photodynamic therapy (PDT) treats malignant tumors using photosensitizers and light. We employed a new pulse laser as the excitation light source for PDT, i.e. an optical parametric oscillator (OPO) system pumped by a Q-switched Nd:YAG laser, because it provides extremely high peak power., Study Design/materials and Methods: The effects of PDT using the photosensitizer Photofrin((R)) and the new laser were evaluated in 12 patients with early gastric cancer., Results: Complete responses (CR) were obtained in 75% of 12 assessable patients, CR was observed in all cases with mucosal carcinoma (response rate 100%).Regarding toxicity, mild photosensitivity was seen in one case and it lasted several weeks. The other major side effect was decrease of total protein, which was observed in six patients (40%), lasting several months. There were no serious abnormalities in symptoms or laboratory tests., Conclusion: We conclude that the YAG-OPO laser is suitable as an excitation light source for PDT.

The patient was a 41-year-old female who became aware of a protuberance in the right frontoparietal vault 2 years ago. Three dimensional CT showed a hyperostosis involving the diploe of the skull, and the rough surface of the inner table. In the gadolinium--DTPA enhanced MR images, an entity with a flame-like appearance invading the swollen skull rose from thick homogenously-enhanced dura. The lesion was surgically resected in a circle, and removed with the adherent dura. Histologically, this lesion exhibited a lobular pattern of meningothelial cells, and roughly invaded into the Haversian canals of the skull through the dura. Postoperatively, there was no neurological or physical deficit. In this paper, we reviewed clinical and pathological features of 73 meningioma en plaque cases including the present case.

Endothelin-1 has been reported to be responsible for gastric mucosal damage in various experimental models. We evaluated the role of endogenous endothelin-1 in the pathogenesis of gastric mucosal damage induced by indomethacin and HCl in the rat. Rats were given indomethacin (25 mg/kg) subcutaneously, and 15 min later, 0.2N HCl intragastrically. Gastric mucosal damage, gastric endogenous endothelin-1, and gastric mucosal hemodynamics were measured. The effects of bosentan, a mixed endothelin receptor antagonist, on gastric mucosal integrity and hemodynamics were assessed. Gastric endogenous endothelin-1 was significantly elevated at 20 min, gastric mucosal blood flow began to decrease significantly at 25 min, and gastric damage occupied 52.2% of the total glandular mucosa at 135 min after injection of indomethacin. Intragastric pretreatment with bosentan (5, 10, 30, and 60 mg/kg) significantly attenuated gastric damage, to 26.1%, 7.7%, 3.6%, and 1.6%, respectively, of the total glandular mucosa. Bosentan (60 mg/kg) prevented the initial decrease of blood flow and, even at 135 min, improved blood flow and hemoglobin oxygen saturation significantly. We suggest that indomethacin-induced endogenous endothelin-1 diminishes gastric mucosal blood flow and tissue oxygenation and ultimately causes gastric damage. Endogenous endothelin-1 may play an important role in the pathogenesis of the acute gastric mucosal lesions induced by indomethacin and HCl.

We report herein the case of a 44-year-old man in whom an asymptomatic dissecting aneurysm was found in the proximal part of the superior mesenteric artery (SMA) during a preoperative evaluation for colon cancer. The patient was managed conservatively with blood pressure control during the perioperative period of the colon resection as the false lumen of the dissecting aneurysm was revealed to be completely occluded by thrombus. The thrombus in the false lumen continued to be absorbed until 1 month after surgery. The patient is currently well 4 years after his operation without any evidence of recurrence of the aneurysm.

We performed contrast-enhanced CT before and after chemotherapy in a patient with advanced gastric cancer to assess the efficacy of neoadjuvant chemotherapy for peritoneal dissemination. The patient was preoperatively given combined chemotherapy with UFT and CDDP. Hepatic metastatic and peritoneal disseminated foci were markedly reduced on CT. Thus CT proved to be useful for assessing peritoneal dissemination and the efficacy of neoadjuvant chemotherapy.

The phenotypic expressions of AFP producing gastric carcinomas were investigated by histological, immunohistochemical, mucinhistochemical and biochemical studies. Intramucosal histology was well differentiated adenocarcinoma in fifteen out of seventeen cases. In the invasive area, papillary or papillary and solid structure of the cancer cells with clear cytoplasms were in fourteen cases, but there were only three cases that showed hepatoid structure. In the mucinhistochemistry, thirteen cases (76%) showed intestinal type mucin. And in the lectin binding property of serum AFP, five of seven cases showed yolk sac tumor like pattern and the other two cases showed hepatic pattern. These results suggests that most of the AFP producing gastric carcinomas derive from intramucosal intestinal type well differentiated adenocarcinoma, that retrodifferentiated to fetal intestine in the invasive area and produce fetal intestinal type AFP.

Neoadjuvant chemotherapy with CDDP and UFT was performed on far advanced gastric carcinoma cases whose curative resection was impossible. These trials were carried out on 10 patients who had Borrmann 4 type carcinoma. PR was found in 6 cases, for an efficacy rate of 60% (6/10). The DNA content in gastric carcinoma was determined before and after treatment by flow cytometry. The relationship between the change of DNA ploidy pattern and effects of chemotherapy was investigated. Aneuploidy was found in 6 of 10 patients (60.0%). DNA ploidy patterns showed no correlation with effectiveness. In aneuploid cases, the group of responders showed seemingly the change of ploidy pattern, from aneuploid to diploid. In non-responders the percentage of aneuploid cells increased. In diploid cases, an accumulation of S-phase fraction was observed in the group of responders. These results suggested that DNA ploidy analysis may provide additional diagnostic criteria for better assessment of chemotherapeutic effects.

We investigated the effect of the anti-ulcer drug cetraxate on the development of the gastric ulcer induced by the submucosal injection of endothelin-1 in the rat gastric body, and its effects on gastric mucosal hemodynamics and tissue oxygenation by Laser doppler flowmetry and tissue spectrophotometry. Endothelin-1 induced gastric ulcer (ulcer length: 11.85 +/- 0.89 mm, mean +/- SEM, n = 4) which was strongly attenuated by cetraxate (ulcer length: 3.27 +/- 0.3 mm, mean +/- SEM, n = 8, p < 0.0001). Cetraxate maintained also tissue oxygenation without causing any significant effect on the endothelin-1-induced changes in gastric mucosal blood flow and volume. These results show that cetraxate exerts its cytoprotective action partly by maintaining mucosal oxygenation.

The exact etiology of irritable bowel syndrome (IBS) is unknown. IBS is probably one of the commonest gastrointestinal disorders, but it has proved to be one of the most difficult conditions to diagnose. A proportion of patients give a strong history of stress-related or stress-evoked symptoms. In the past there has been a paucity of studies of this disorder because of difficulties in patient selection, choice of appropriate marker to be tested and the correlation of findings with the clinical presentation. A clear and precise definition of IBS is of most importance in the understanding of psychopathophysiological markers in this disorders.

To clarify the difference in the protein composition of pancreatic juice between patients with pancreatic cancer and normal controls, the proteins of pure pancreatic juice from three cases of cancer of the head of the pancreas and six apparently healthy adults were analyzed by two-dimensional gel electrophoresis (two-DE) followed by silver staining. Two minor proteins of Mr 59,000 and Mr 78,000 present in all the three patients were not detected in the six controls. We have identified the minor proteins with Mr 59,000 and Mr 78,000 as alpha 1-antitrypsin and transferrin, respectively, using Western blotting with anti-alpha 1-antitrypsin and anti-transferrin antibodies. In addition, serum albumin also identified by antibody binding was abundantly present in patients compared to controls. The increase in the amount of serum albumin in the patient was also confirmed by a quantitative analysis using SDS-PAGE and gel densitometry. The data indicate that not only serum albumin but also alpha 1-antitrypsin and transferrin are increased in the pancreatic juice of the patients with pancreatic cancer, as compared with apparently healthy adults. The data also suggests that the analysis of pancreatic juice proteins by two-DE with silver staining is useful for the diagnosis of pancreatic diseases.

To investigate the time course and the prognosis of patients with depressive disorder in industry, 60 workers with major depression (DSM-III) selected from two companies were interviewed. Average follow-up years for subjects after returning to their job was 3.5, ranging from 1 to 8. About half of the subjects relapsed and two-thirds changed their job within 5 yr after returning to their job. One case committed suicide. Subjects tended to relapse within the first 4 yr and under the same precipitating situation as at their onset phase. Fifty percent of the subjects indicated "very good" or higher social adjustment according to Axis V (DSM-III). Enough rest days at the onset and no relapse significantly correlated with higher social adjustment in the subjects within 2 yr after the return. In the subjects followed-up for 3 yr or more, marital status, education, no higher occupational status, fewer relapses, and support for them by both industrial health services and worksite supervisors were found to be significant predictors of higher adjustment. The results suggested that, in order to prevent relapses and improve social adjustment of workers with major depression, the mental health team in industry should provide continuous and careful support for them, for at least 4 yr after returning to their job.