Early Triple Carcinomas Metachronously Involving the Sigmoid Colon, Stomach and Gallbladder Report of a Case

We present a case of early triple carcinomas metachronously involving the sigmoid colon, stomach and gallbladder in order to emphasize that a mass screening is useful in the detection of early cancer of the alimentary tract. A 61-year-old male was admitted to the hospital for investigation of a flat elevated lesion of the sigmoid colon. The patient received partial resection of the sigmoid colon with the diagnosis of carcinoma. Pathologic findings showed adenocarcinoma confined to the mucosa. Sixteen months after surgery, a depressed stomach lesion was found through a mass screening. Distal gastrectomy was performed because of carcinoma, which was histologically confined to the mucosa. Sixty-five months later, he underwent cholecystectomy because of a polypoid lesion of the gallbladder. Pathologic findings disclosed adenocarcinoma infiltrated into the muscular layer of the gallbladder. The patient is currently in good health about 4 years after undergoing cholecystectomy. Zusammenfassung Wir berichten über einen Fall von drei Frühkarzinomen, die metachron in Sigmoid, Magen und Gallenblase auftraten, um darauf hinzuweisen, dass ein Massenscreenig zur Entdeckung von Frühkarzinomen des Verdauungstraktes sinnvoll ist. Ein 61-jähriger Mann wurde zur Abklä,rung einer flach erhöhten Läsion des Sigmoids stationär aufgenommen. Der Patient unterzog sich einer Teilresektion des Sigmoids mit der Diagnose eines Karzinoms. Die pathologische Aufarbeitung ergab ein Adenokarzinom, das auf die Mukosa beschränkt war. 16 Monate nach der Operation zeigte sich bei einer Reihenuntersuchung eine indurierte Magenläsion. Es folgte eine distale Gastrektomie aufgrund eines Karzinoms, das auf die Mukosa begrenzt war. 65 Monate später musste sich der Patient wegen einer polypoiden Läsion der Gallenblase einer Cholezystektomie unterziehen. Die pathologischen Befunde ergaben ein Adenokarzinom, das die Muskelschicht der Gallenblase infiltriert hatte. Der Patient is zur Zeit, etwa vier Jahre nach der Cholezystektomie, bei guter Gesundheit.     

Analysis of the mechanism of allograft rejection and cell-mediated immunity. II. Divergent effect of CY pretreatment on the generation of cytotoxic activity in the draining lymph nodes and spleen

CY pretreatment augmented the generation of cytotoxicity in the draining lymph node cells in mice after subcutaneous immunization with allogeneic spleen cells, or in the non-adherent peritoneal exudate cells after intraperitoneal immunization with these cells. Marginal cytotoxicity in the spleen cells after this immunization was suppressed by CY pretreatment. Similar divergent effect of CY pretreatment on the generation of cytotoxic activity in the draining lymph nodes and the spleen was also observed after immunization with allogeneic tumour cells which can induce high degrees of cytotoxicity without CY pretreatment. These results indicate that cytotoxic T lymphocyte (CTL) generation at the site of direct graft rejection appears to have a nature different from that related to CTL generation in the spleen. A discussion is made as to the role of CTL in the peripheral site and the spleen in cases of in vivo allograft rejection.     

Inhibitory Activities of Gatifloxacin (AM-1155), a Newly Developed Fluoroquinolone, against Bacterial and Mammalian Type II Topoisomerases

We determined the inhibitory activities of gatifloxacin against Staphylococcus aureus topoisomerase IV, Escherichia coli DNA gyrase, and HeLa cell topoisomerase II and compared them with those of several quinolones. The inhibitory activities of quinolones against these type II topoisomerases significantly correlated with their antibacterial activities or cytotoxicities (correlation coefficient [r] = 0.926 for S. aureus, r = 0.972 for E. coli, and r = 0.648 for HeLa cells). Gatifloxacin possessed potent inhibitory activities against bacterial type II topoisomerases (50% inhibitory concentration [IC₅₀] = 13.8 μg/ml for S. aureus topoisomerase IV; IC₅₀ = 0.109 μg/ml for E. coli DNA gyrase) but the lowest activity against HeLa cell topoisomerase II (IC₅₀ = 265 μg/ml) among the quinolones tested. There was also a significant correlation between the inhibitory activities of quinolones against S. aureus topoisomerase IV and those against E. coli DNA gyrase (r = 0.969). However, the inhibitory activity against HeLa cell topoisomerase II did not correlate with that against either bacterial enzyme. The IC₅₀ of gatifloxacin for HeLa cell topoisomerase II was 19 and was more than 2,400 times higher than that for S. aureus topoisomerase IV and that for E. coli DNA gyrase. These ratios were higher than those for other quinolones, indicating that gatifloxacin possesses a higher selectivity for bacterial type II topoisomerases.     

Recent view of gastro-esophageal reflux disease according to the guideline for gastric ulcer treatment

The guideline for gastric ulcer treatment in Japan recommends eradication of Helicobacter pylori (H. pylori) for the first choice. Recently, it is well known that some patients develop gastro-esophageal reflux disease (GERD) after successful eradication. H. pylori infection may play a protective role against GERD by impairing gastric acid secretion. Acid secretion is influenced by the distribution of gastritis in the stomach. Antrum-predominant gastritis is associated with gastric hypersecretion. Patients with corpus-predominant gastritis have decreased acid secretion. The latter is common in Japan and at high risk of GERD after eradication. To arise GERD, both acid secretion and reflux of acid caused by hiatus hernia or gastro-esophageal dysmotility are needed. Although most of GERD developed after eradication are mild, severe GERD are also experienced at times. Recent view of GERD and H. pylori infection is described.     

Rapid freehand scanning three-dimensional echocardiography: accurate measurement of left ventricular volumes and ejection fraction compared with quantitative gated scintigraphy.

This study was performed to assess clinical feasibility of rapid freehand scanning 3-dimensional echocardiography (3DE) for measuring left ventricular (LV) end-diastolic and -systolic volumes and ejection fraction using quantitative gated myocardial perfusion single photon emission computed tomography as the reference standard. We performed transthoracic 2-dimensional echocardiography and magnetic freehand 3DE using a harmonic imaging system in 15 patients. Data sets (3DE) were collected by slowly tilting the probe (fan-like scanning) in the apical position. The 3DE data were recorded in 10 to 20 seconds, and the analysis was performed within 2 minutes after transferring the raw digital ultrasound data from the scanner. For LV end-diastolic and -systolic volume measurements, there was a high correlation and good agreement (LV end-diastolic volume, r = 0.94, P <.0001, standard error of the estimates = 21.6 mL, bias = 6.7 mL; LV end-systolic volume, r = 0.96, P <.0001, standard error of the estimates = 14.8 mL, bias = 3.9 mL) between gated single photon emission computed tomography and 3DE. There was an overall underestimation of volumes with greater limits of agreement by 2-dimensional echocardiography. For LV ejection fraction, regression and agreement analysis also demonstrated high precision and accuracy (y = 0.82x + 5.1, r = 0.93, P <.001, standard error of the estimates = 7.6%, bias = 4.0%) by 3DE compared with 2-dimensional echocardiography. Rapid 3DE using a magnetic-field system provides precise and accurate measurements of LV volumes and ejection fraction in human beings     

Local forearm vasodilation with intra-arterial administration of enalaprilat in humans.

To determine whether converting enzyme inhibitors could produce peripheral vasodilation through a local mechanism, we infused enalaprilat, 2 micrograms/min/dl forearm volume (FAV), into the brachial artery of normal subjects and measured changes in forearm blood flow (FBF) with strain-gauge plethysmography. Enalaprilat produced a peak increase in FBF of 2.82 +/- 0.54 ml/min/dl FAV (78% increase) at 1 minute (p less than 0.01 versus vehicle) and an increase of 1.11 +/- 0.28 ml/min/dl FAV at 4 minutes (p less than 0.05 versus vehicle). Blood pressure and plasma renin activity measured at the completion of infusion did not change. Intravenous enalaprilat infusion at the same dose in seven additional normal subjects did not increase FBF. Pretreatment of seven subjects with 75 mg oral indomethacin attenuated the peak response to enalaprilat (4.13 +/- 1.52 versus 0.58 +/- 0.32 ml/min/dl; p less than 0.05). We conclude that intra-arterial enalaprilat produces an increase in FBF in normal subjects. This peripheral vasodilation is caused by a local effect independent of circulating renin-angiotensin system inhibition. This response is attenuated by indomethacin, suggesting that prostaglandins contribute to the vasodilator response.