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A small-cell carcinoma combined with adenocarcinoma of the gallbladder was detected in a 71-year-old Japanese woman. A nodular mass measuring 4.0 x 5.0 cm was located in the fundus of the gallbladder, in which a tiny depressed lesion measuring 2 mm in diameter was macroscopically and stereomicroscopically observed. Histologically, the depressed area revealed small-cell carcinoma that consisted of atypical cells with small, round to oval nuclei and scanty cytoplasm and was surrounded by ordinary well-differentiated adenocarcinoma. Immunohistochemically, the tumor cells in an adenocarcinomatous area were diffusely positive for carcinoembryonic antigen and showed an interspersed positivity to serotonin and gastrin, while the tumor cells in the small-cell carcinoma area were negative for both antigens. The nuclear DNA content of the tumor cells of both components was aneuploid; however, the first G0/G1 peak of the small-cell carcinoma was much smaller than that of the adenocarcinoma. These results indicated that the tumor revealed a divergence in functional differentiation, and this feature suggested an initial phase of composite small-cell carcinoma and adenocarcinoma in the gallbladder.

Conventional plastic teeth (CV teeth) are inferior to porcelain teeth in maintaining an adequate esthetic appearance with wear and discoloration, and thus have a shorter period of durability. Recently, high-strength plastic teeth (HS teeth) have been developed and applied to overcome the wear problems of CV teeth. Since HS teeth made of hard resin are still susceptible to staining with pigments, it has been observed that the esthetics of removable partial dentures made from such plastic teeth are gradually impaired in many patients. To investigate the susceptibility of HS teeth to pigments, we conducted an in vitro study by immersing three types of artificial teeth in three coloring liquids. It was found that the HS teeth tended to be less susceptible to the test pigments than the CV teeth to various degrees. In contrast, they showed markedly stronger susceptibility to the pigments than porcelain teeth. For all three artificial tooth types, daily tooth cleaning with an ultrasonic vibrator had a tendency to reduce the coloration in comparison with their counterparts without ultrasonic cleaning.

We studied 71 patients with solid-type gastric adenocarcinoma selected from 5,437 surgically resected specimens during the period from 1975 to 1988; six had vimentin-positive adenocarcinomas, and five of these were advanced. One was at an early stage. All six tumors showed the same histologic features and had either a diffuse or alveolar arrangement, with tumor cells having either poor or no cohesiveness. Many tumor cells were round to polygonal, with eosinophilic or clear cytoplasm and large, eccentric vesicular nuclei, as seen in malignant rhabdoid tumors of the kidney. In all cases, the cytoplasm showed coexpression of vimentin and cytokeratin as revealed by double immunostaining. Four of the five cases with advanced carcinoma died of the disease 1 to 6 months after surgery. The cases with vimentin-positive tumors had significantly poorer prognoses than those with vimentin-negative tumors. We also studied adenocarcinomas of various histologic types randomly selected from our file (160 intestinal type and 69 diffuse type of Lauren) but failed to detect any vimentin positive ones. These results indicate that vimentin is expressed in some of the solid-type adenocarcinomas, which have a poor prognosis, and indicating that rhabdoid-like cells may be found in a variety of adenocarcinomas of the stomach.

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenectomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that preoperative serum carcino-embryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings support the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow up.

Co-Cr alloy is used more frequently than Ni-Cr alloy as a non-precious alloy for cast plates in Japan. However, since the melting temperature of Co-Cr alloy is very high, about 1300 degrees C, and since it oxidizes easily, a vacuum-pressure casting machine capable of melting this alloy in a reduced atmosphere has recently been developed. Using this machine, the effects of fusion temperature and the heating temperature of the cast ring on the Co-Cr alloy were studied. It was found that in the vacuum-pressure casting method, both the fusion temperature of the Co-Cr alloy and the heating temperature of the cast ring had a significant effect (p < 0.01) on the castability of the Co-Cr alloy.

Since secondary bile acids have mutagenic potency and choledochal cyst patients with or without cyst-enterostomy have a high risk of developing bile duct carcinoma, we examined the hypothesis that secondary bile acids are elevated in the choledochal cyst and possibly cause biliary tract carcinoma. Eleven choledochal cyst patients with or without previous cyst-enterostomy or biliary tract carcinoma, seven patients with biliary tract carcinoma not associated with choledochal cyst and five patients with cholecystolithiasis were examined. Samples were directly needle aspirated from the cyst or by cannulating a tube into the common bile duct through the cystic duct. The concentrations of each bile acid in these samples were quantified by gas-liquid chromatography and compared. Neither the relative composition nor the absolute concentration of secondary bile acids (deoxycholic acid, lithocholic acid) elevated in patients with choledochal cyst compared with the values in the non-choledochal cyst patients with or without biliary tract carcinoma. The presence of biliary tract carcinoma or previous cyst-enterostomy did not affect the concentrations of secondary bile acids. The results suggest that the factor other than secondary bile acids can be primarily responsible for the high risk of bile duct carcinoma in patients with choledochal cyst.

1. 7-Ethyl-10-[4-(piperidino)-1-piperidino] carbonyloxycamptothecin (CPT-11), a potent anticancer agent currently under development for clinical use, is metabolized in vivo to 7-ethyl-10-hydroxycamptothecin (SN-38), which is subsequently conjugated to 7-ethyl-10-hydroxycamptothecin glucuronide (SN-38-glucuronide). The SN-38-glucuronide was hydrolysed by beta-glucuronidase from E. coli to aglycones and glucuronic acid. 2. Four purified natural glucuronides including baicalin, wogonoside, luteolin-3'-glucuronide, and glycyrrhizin, inhibited beta-glucuronidase using SN-38-glucuronide as substrate. The inhibition potencies of these natural glucuronides toward beta-glucuronidase were similar to that of saccharic acid 1,4-lactone. 3. These results indicate that plant materials of Kampo (Japanese herbal) medicines containing these glucuronides could be used in vivo to decrease the enterohepatic circulation of SN-38 and possibly that of other drugs.

An in vitro evaluation of abrasive wear resistance of high-strength denture (HS) teeth and wear of metal plates (Pd alloy) on the opposing side was conducted. A total of 8 types of teeth were used in the experiments including 3 types of HS teeth, 3 types of conventional plastic denture (PL) teeth, porcelain teeth and metal teeth (Pd alloy). Sliding-induced wear tests were conducted by sliding these teeth over the metal plates. Abrasive wear resistance of the teeth was evaluated in terms of wear depth and weight loss. A comparison of wear depth showed that the abrasive wear resistance of HS teeth was 4.7 times that of PL teeth, 0.7 times that of porcelain teeth and 8.3 times that of metal teeth. Weight loss showed that the abrasive wear resistance of HS teeth was 3.3 times that of PL teeth, 0.2 times that of porcelain teeth and 11.4 times that of metal teeth. The weight loss of the metal plates was minimal when they slid over HS teeth, but increased in the order PL teeth, porcelain teeth and metal teeth.

A case of primary pancreatic enterochromaffin cell (EC cell) carcinoid tumor in a 66-yr-old Japanese man is presented. The markedly dilated main pancreatic duct was noticed at the time of an incidental ultrasonogram during hospitalization for diabetes mellitus. Endoscopic retrograde pancreatography showed stenosis of the main pancreatic duct at the body of the pancreas and dilated pancreatic ducts distal to the obstruction. A distal pancreatectomy was performed, together with splenectomy. Macroscopically, the main pancreatic duct was compressed by a fibrous mass around the duct, and the pancreatic ducts distal to the tumor were markedly dilated. Histologically, the tumor was composed of uniform round cells, proliferating in small nests or trabeculae. The tumor cells were strongly positive with both Grimelius and Fontana-Masson stains. The immunohistochemical study disclosed the tumor cells to be positive for serotonin and chromogranin. This is a rare case of primary pancreatic EC cell carcinoid tumor with obstructive pancreatitis.

An in vitro study was conducted to evaluate the abrasive wear resistance of high-strength denture teeth (HS teeth). Eight types of specimen were used in the experiments; 3 types of HS teeth, 3 types of conventional plastic denture teeth (PL teeth), porcelain teeth and metal teeth. Sliding-induced wear tests were conducted by sliding the samples on a metal plate. The abrasive wear resistance of the samples was evaluated in terms of wear depth, weight loss and SEM observation. Comparison of wear depth showed that abrasive wear resistance of HS teeth was 4.7 times that of PL teeth, 0.7 times that of porcelain teeth and 8.3 times that of metal teeth. In terms of weight loss, the corresponding values were 3.3-fold, 0.2-fold and 11.4-fold, respectively.

A clinicopathologic study of 40 cases of carcinoma of the gallbladder is presented. Twenty-six cases resected were assessed retrospectively with respect to the operative procedures employed and the results based on the pathologic findings from the resected specimens. The relationship between clinical features, macroscopic forms of tumor, histological types, liver invasion, and lymph node metastasis were investigated. Papillary, papillary infiltrative and nodular forms were classified as either papillary adenocarcinoma or well-differentiated tubular adenocarcinoma and invasion of the liver and lymph node metastasis were rare. Frequent lymph node metastasis was encountered in the nodular infiltrative form and invasion of the liver was frequently present in the infiltrative form. Invasion of the liver, lymph node metastasis, and the presence of gallstones were less frequent in papillary adenocarcinoma. In contrast, moderately-differentiated tubular adenocarcinoma frequently had lymph node metastasis. Invasion of the liver and lymph node metastasis were, however, present regardless of the histologic types and were more related to the extent of subserosal involvement present. A female preponderance was noted in poorly-differentiated adenocarcinoma. The main reasons for surgery being limited to exploratory laparotomy only or palliative procedures included carcinoma infiltration into the hepatoduodenal ligament, carcinoma extension to the neighboring structures, multiple liver metastases, peritoneal dissemination, large liver invasion, and multiple metastases to the paraaortic lymph nodes.

High-strength denture teeth (HS teeth) were developed in order to improve the hardness and wear resistance of conventional plastic denture teeth (PL teeth), while retaining their feature of easy occlusal adjustment. The objective of this study was to evaluate the abrasive wear resistance of HS teeth. We conducted wear tests and measured surface roughness using six types of anterior artificial teeth, i.e., three types of HS teeth and three types of PL teeth, the latter serving as the control. The results of the toothbrush abrasion test revealed that the HS teeth had about 5 times greater wear resistance than the PL teeth. It was also found that the type of artificial teeth and the number of abrasive wear-testing strokes had a significant (P less than 0.05) influence on the surface roughness of artificial teeth.