Nonulcerative Lesion Detected by Endoscopy as an Early Expression of Gastric Malignancy: --Retrospective Observation of 72 Cases of Gastric Carcinoma--

To evaluate the endoscopic criteria for early malignant findingsof gastric carcinoma more precisely, a retrospective examinationof endoscopic pictures of 72 patients with gastric carcinomawas carried out. The patients had received endoscopic examinationsrepeatedly for years and proceeded finally to surgery on thebasis of a diagnosis of carcinoma by gastric biopsy. The macroscopicas well as microscopic findings of the resected specimens werecompared with the previous endoscopic observations. Ulcerative lesions were predominantly found at the initial endoscopyin patients whose final diagnosis was the lie type of earlygastric cancer or IIc-like advanced cancer. These patients usuallyreceived endoscopic examinations repeatedly and their lesionswere diagnosed as malignant by the adopted criteria of earlygastric cancer 2 to 6 yr after the initial examination. In contrast, nonulcerative lesions were observed more frequentlyat the initial examination in patients with the final diagnosisof the IIa+IIc type of early gastric cancer or Borrmann typeof advanced cancer. In most of those patients endoscopic examinationwas not carried out so frequently, and in some of those whohad been closely followed the malignant findings appeared rathersuddenly with tumorous formation as well as deeper invasionduring less than a few years from the previous examination atwhich the tumor had been considered benign. These data indicate that the nonulcerative lesions which wereconsidered benign could be the early expression of gastric carcinoma.It should be stressed that nonulcerative lesions such as "irregularerythematous change, discoloration, flat granular change" and"simple mucosal depression" observed in some parts of the stomachwould be important site for the detection of early gastric carcinoma,and that these lesions need to be biopsied more frequently.     

Signet-ring cell carcinoma of the prostate effectively treated with maximal androgen blockade

Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.     

Monoclonal Gammopathy in Adult T-Cell Leukemia/ Lymphoma: A Report of Three Cases

Adult T-cell leukemia/lymphoma (ATL/L) is clustered in southwesternJapan, especially in the Nagasaki and Kagoshima areas. It wasshown that this clustering correlated with the presence of antibodiesto antigens of a new C-type RNA leukemia virus. Surface markeranalysis of neoplastic T-cells of ATL/L patients shows the helper/inducerphenotype (Leu-1⁺, Leu-2a^– and Leu-3a⁺). On the other hand, the association between T-cell malignancyincluding ATL/L and monoclonal gammopathy is very rare. Threeunique cases of ATL/L with monoclonal gammopathy are reported.Yet the meaning of an M-component in T-lymphocytic proliferationremains uncertain. The relationship between the leukemia virus,ATL/L-cells and monoclonal gammopathy is discussed.     

Dispersion of Filtered P Wave Duration by P Wave Signal-Averaged ECG Mapping System:

INTRODUCTION: Although it is desirable to know drug efficacy before initiating antiarrhythmic therapy, there have been no methods for this evaluation. P wave signal-averaged ECG (P-SAECG) is useful to detect subtle changes in disturbance of atrial conduction. The purpose of this present study was to test whether P-SAECG mapping system would give any information on the efficacy of disopyramide on the prevention of paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: P-SAECG was performed before disopyramide treatment, at 3 hours after a single dose of oral disopyramide (200 mg), and after 4 weeks of disopyramide treatment (300 mg/day). After measuring the filtered P wave duration by the vector magnitude and mapping methods, we calculated filtered P wave duration dispersion, difference between the maximal and minimal filtered P wave duration within 16 chest leads at these three time points. Filtered P wave duration and filtered P wave duration dispersion before treatment were longer in 32 patients with symptomatic PAF than in 31 healthy volunteers. Disopyramide was effective for suppression of PAF in 17 patients and ineffective in 15 patients after 4 weeks of treatment. Filtered P wave duration was similarly prolonged at 3 hours in the two groups, whereas filtered P wave duration dispersion at 3 hours after the disopyramide administration behaved differently; it decreased in all of the effective group and increased in all of the ineffective group. The effective patients were prospectively followed with the same treatment for 6 months. In 16 (94%) of these 17 effective patients, no PAF was documented and they remained to be asymptomatic. CONCLUSIONS: Thus, measuring filtered P wave duration dispersion with the P-SAECG mapping method after a single administration may predict the long-term efficacy of disopyramide in patients with PAF.     

Prospective follow-up study of hepatitis C virus infection in patients undergoing maintenance haemodialysis: Comparison among haemodialysis units

A prospective follow-up study on hepatitis C virus (HCV) infection was conducted in seven haemodialysis units from April 1990 to March 1995. A total of 634 patients were undergoing maintenance haemodialysis in the seven units. Of those, 302 patients participated in the follow-up study; 179 were initially HCV antibody negative and 123 were initially positive. Nine of the 179 initially negative patients became positive for HCV antibody during the follow-up period. In accordance with the appearance of HCV antibody, indicating new infection of HCV, all nine of these patients were diagnosed with HCV viraemia. As no other routes were apparent, HCV infection in all nine patients was likely due to nosocomial transmission. Prevalence of HCV antibody at the start of follow up was significantly higher ( P < 0.001) in haemodialysis units A-C (37.9%) than in haemodialysis units D-G (17.0%). Incidence of new HCV infection was significantly higher ( P = 0.005) in the former units (2.2% per year) than in the latter (0.2% per year). Ten of the 123 patients who were initially positive for the HCV antibody exhibited a loss of reactivity during the follow-up period; of these 10 patients, nine were negative for HCV-RNA from the start of the study. In conclusion, the incidence of new HCV infection seen in patients undergoing haemodialysis suggests that their risk of acquiring HCV infection is directly related to the prevalence of HCV antibody positive patients being treated in the units.     

A Comparative Study of the Pancreatogram and the Histological Findings in 2,2'-Dihydroxy-Di-N-Propylnitrosamine-Induced Pancreatic Carcinoma in Golden Hamsters

2,2'-dihydroxy-di-N-propylnitrosamine (DHPN) at a dose of 250mg/kg was injected subcutaneously into 28 male Syrian goldenhamsters once a week. They were sacrificed and dissected atintervals of one to two weeks beginning from the 8th week untilthe 20th week after the injection. Pancreatography was performedon every hamster and the chronological changes in their pan-creatogramswere compared with the histological findings. Marked atypicalhyperplasia almost indistinguishable from carcinoma in situwas observed his-tologically beginning at the 13th week, andinfiltrating adenocarcinoma was seen in all the hamsters inand after the 16th week. The pancreatography made it possibleto depict even minute changes at an early stage that correspondedto the histological findings. One example was that a slightstenosis in the branch was detected at the 13th week and thepicture of stenosis was observed in the main pancreatic ductat the 14th–15th week. This was followed by obstructionin and after the 16th week. These findings support the possibility that the neoplastic processin the hamster pancreas occurs in the branch region earlierthan in the main pancreatic duct.     

Effects of artificial blood (FC-43 emulsion) on myocardial energy metabolism in the rat heart-lung preparation

We have assessed the effects of artificial blood (FC-43 emulsion)on myocardial energy metabolism in the rat heart-lung preparation.Animals were allocated to four groups (n = 8 each group) accordingto the ratio of perfusion blood and FC-43 as follows: group1 = control, perfusion blood only; group 2 = 50% FC-43; group3 = 75% FC-43; and group 4 = 100% FC-43. Hearts were perfusedinitially to a cardiac output of 30 ml min^–1 and meanarterial pressure of 50 mm Hg. Thirty minutes after perfusion,the hearts were freeze-dried for 6 days. Myocardial high energyphosphates (ATP, ADP and AMP) were measured by high pressureliquid chromatography. Myocardial lactate and glycogen concentrationswere measured by enzymatic methods. There were almost no significantdifferences in cardiac output, systolic pressure, right atrialpressure and heart rate among the groups. Oxygen contents ofthe perfusate in all FC-43 groups were significantly lower thanthose in the control group. Myocardial ATP concentrations inrats receiving 50%, 75% and 100% FC-43 were significantly lowerthan those in the control group. In addition, myocardial ADPand AMP concentrations in rats receiving 75% and 100% FC-43were significantly higher than those in the control group. Althoughthere is adequate oxygen-carrying capacity in FC-43 to maintaincardiac function during perfusion, the energy levels in thehearts perfused with FC-43 were lower than those in normal hearts.     

Two Cases of Carcinoid Tumor of the Stomach which Responded to Oral Coadministration of Tegafur and Uracil

Tegafur, 1-(2-tetrahydrofuryl)-5-fluorouracil, was administeredin combination with uracil to two patients with carcinoid tumorof the stomach and the effect of the drug was evaluated. The first patient was a 67-yr-old woman. She was admitted becauseof an upper abdominal tumor. Exploratory laparotomy revealeda gastric tumor and an additional huge tumor with liver metastasisand peritoneal dissemination. Histological examination of biopsyspecimens from the gastric tumor and metastatic lesions revealedcarcinoid tumor. Tegafur and uracil were coad-ministered postoperatively.During three months of treatment the gastric tumor improvedendoscopically and the large abdominal tumor decreased from10x10 cm to 4x4 cm. The second patient was a 55-yr-old man. He was admitted becauseof severe diarrhea. Biopsy from a gastric lesion and metastaticskin lesions revealed carcinoid tumor. After coadministrationof tegafur and uracil and mitomycin C, the metastatic skin lesionsbecame smaller and some of the lesions disappeared. The liveralso decreased in size. These two cases suggest the possibility that coadministrationof tegafur and uracil may be effective for carcinoid tumor ofthe stomach.