Clinicopathologic Studies of Gastric Cancer with Metastasis to the Liver--Based on the Cases Detected at Initial Surgery

A total of 3,010 patients with gastric cancer were operatedon in our surgical department during the 13-year period from1968 to 1980. Out of these, 204 patients with liver metastasisdetected at the initial surgery were studied. The incidence was 6.8%. The primary lesion was resected in 104of the 204 cases. Male patients comprised about 75% and 60-to 69-year-old patients constituted about 45%. In relation tothe site of the primary lesion, cancer invading to all areasof the stomach comprised 44% of the nonresected group, whilecancer located in the lower portion was more frequent than thatin the upper portion in the resected group. The resected stomachwas analyzed histopatholo-gically. Most of the cancers belongedto Borrmann gross types II and III. Histologically, papillaryand well- or moderately differentiated tubular adeno-carcinomasconstituted 65% and medullary type 61.5%. Concerning the prognosis,median survival in the resected group was two to three monthslonger than in the nonresected group. When chemotherapy wasperformed, survival was prolonged a further two to three months.     

Neuroendocrine carcinoma of the liver: An autopsy case

An autopsy case of hepatic neuroendocrine carcinoma Is descrlbed. An 84-year-old man had a white solid tumor measuring 5 cm In greatest diameter and multiple small nodules In the non-cirrhotic liver. Microscopically, these lesions were characterized by solid nesting, trabecular, and Insular arrangements of small- to medium-sized cells. The tumor cells were argyrophllic and electron microscopy showed dense core granules and formation of bile canall-culi. lrnmunohlstochernlcally, the tumor cells were positive for cytokeratln CAM 5.2, chromogranln A, Leu-7, neuron-specific enolase, and α-fetoprotein. The tumor was diploid by flow cytometry. The patient had metastases in the vertebrae, lung, pancreas, and an hepatic hilar lymph node. The patient had an occult rectal tumor of Intramucosal well-differentiated tubular adenocarcinoma without metastasis. No alternative primary source of the endocrine tumor was detected. The patient died 1 month after presentation.     

SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL EPIDEMIOLOGIC STUDY IN JAPAN

Background. Systemic lupus erythematosus (SLE) is designated by the Japanese government as one of the intractable diseases and all patients, who suffer from these diseases, are registered to get financial aid for treatment. Using newly registered SLE patients, a case-control study was conducted to evaluate potential risk factors. Methods. Two-hundred and eighty-two women SLE patients, newly registered to receive financial aid for treatment, and 292 randomly selected health examination participants at public health centers (controls) were surveyed from April 1988 through March 1990. By means of a self-administered questionnaire, data concerning demographic variables, smoking and drinking habits, past medical and reproductive history, and family history were collected. Results. Based on unconditional logistic regression analysis, the risk of SLE was significantly increased for current smokers (age-adjusted odds ratio (OR) = 2.31, 95% confidence interval (CI) (1.34–3.97). Alcohol and milk intake were inversely associated with risk. Family histories of asthma and collagen diseases, including SLE, were associated with significantly elevated risk of SLE (OR = 2.07, 95% ci 1.14–3.77; OR = 5.20, 95% CI 1.08–24.95, respectively). Regarding reproductive function, women with menarche at age 15 or later had significantly higher risk than those, who started menstruating before age 12 (OR = 3.82, 95% CI 1.66–8.81 for menarche at > 15 years and OR = 2.90, 95% a 1.14–7.39 for menarche at 16y). Conclusions. Our study suggests several risk factors, including smoking, family history, and reproductive history that may increase the risk of SLE.     

Predominant Production of Amniotic Interleukin-1α in Cases With Premature Rupture of the Membranes

PROBLEM: The physiological significances of the two known subtypes of interleukin-1 (IL-1) in amniotic fluid (AF) were examined by measurements of their concentrations and detection of their location. METHOD: Each IL-1 subtype in AF collected from 61 patients were examined by newly developed enzyme-linked immunosorbent assay with high sensitivity. Placenta and umbilical cord from 17 patients were examined immunohistochemically for localization of IL-1. RESULTS: Different types of IL-1 were predominant in AF; the mean (± SE) concentration of IL-1β (412.8 ± 105.4pg/ml) was significantly higher (P<0.01) than that of IL-1α(116.4± 26.7 pg/ml) in cases with spontaneous vaginal delivery, whereas the concentration of IL-1α (243.1 ±81.4pg/ml) was significantly higher(P<0.01)than that of IL-1β (139.7±59.4pg/ml) in cases with premature rupture of the membranes (PROM) without intrauterine infection. In these cases, immunohistochemical studies revealed the presence of IL-1α in the trophoblastic layer of the placenta and epithelium of the umbilical cord. CONCLUSIONS: Amniotic IL-1α was detected predominantly in cases with PROM, and it is thought to be produced in placenta and fetal skin keratinocyte.     

Chemosensitivity test for repeated arterial infusion chemotherapy by reservoir for unresectable hepatocellular carcinoma

The experimental and clinical usefulness of a chemosensitivity test (Nuclear Damage Assay) was studied. Karyologic degenerative changes were observed as an indicator of drug sensitivity, in repeated arterial infusion chemotherapy (RAIC) using a reservoir for advanced hepatocellular carcinoma (HCC). In the experimental study, this sensitivity test was performed using five liver cell lines against 15 drugs. At the same time, the succinate dehydrogenase inhibition (SDI) test was also performed. Comparison of the results between these two tests gave a high consistency rate of 81%. Clinically, the karyologic sensitivity test was carried out in 135 patients with unresectable HCC. Drug sensitivity could be evaluated in as many as 89% of the total 135 patients. Of the patients, 43 received RAIC on an outpatient basis via a subcutaneously implanted reservoir. The objective response of RAIC on tumours of the 43 patients was evaluated as complete response, partial response, in 3 (9%) and 8 (23%) in 35 patients treated with positive drugs (positive group), and as 0 (0%) and 0 (0%) of 8 patients treated with negative drugs (negative group), respectively. As regards the prognosis, 1 year and 1.5 year survival rates were 70 and 45% in the positive group, and 42 and 0% in the negative group, respectively. As objective response in the positive group tended to be better than that in the negative group, and prognosis in the positive group was significantly better than that in the negative group, this sensitivity test appears to contribute to the improvement of therapeutic results if used to select drugs suitable for RAIC for advanced HCC.     

Diagnosis of Chronic Pancreatitis by Endoscopic Ultrasonography

Abstract: This study evaluates the usefulness of endoscopic ultrasonography in the diagnosis of chronic pancreatitis. 52 patients with chronic pancreatitis, which included 15 cases of mild pancreatitis, 19 cases of moderate pancreatitis and 18 cases of advanced pancreatitis, were diagnosed by endoscopic retrograde cholangiopancreatography and further investigated by endoscopic ultrasonography. The 4 main findings of 1) dilatation of the main pancreatic duct, 2) irregularity of the main pancreatic duct, 3) inhomogeneity of the pancreatic parenchyma and, 4) irregular configuration of the pancreas were reviewed. In all of the 18 cases of advanced pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas were seen. 89% of these patients had dilatation of the main pancreatic duct. In the patients with moderate pancreatitis, on the other hand, all 4 findings occurred with a frequency of between 58% to 95%. In the patients with mild pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas occurred at a rate of 40% to 93%, and dilatation of the main pancreatic duct occurred rarely in only 13% of the patients. We were able to detect abnormalties in the pancreatic parenchyma by endoscopic ultrasonography even in the early stages of chronic pancreatitis, and this suggests that this technique may be useful in the diagnosis of mild pancreatitis, which usually causes quite minor abnormal changes in the main pancreatic duct.