Lymph node metastasis or vessel invasion may occur in superficial esophageal squamous cell carcinoma when it invades the muscularis mucosae. Membrane type 1-matrix metalloproteinase (Mtl-MMP) and CD44 variant 6 (CD44v6) are reported to play an important role in cancer invasion and metastasis.Therefore, we investigated whether Mtl-MMP and CD44v6 may be useful factors for prognosis and indication of endoscopic mucosal resection (EMR) in superficial esophageal carcinoma and whether the two parameters have any relationships. Seventy patients with superficial squamous cell carcinomas curatively resected without additional treatment between 1991 and 2000 at the Kanagawa Cancer Center were analyzed for Mtl-MMP and CD44v6 expression by immunohistochemical staining. The expression of Mtl-MMP was 28.6%, and it significantly correlated with depth of invasion and lymph node metastasis. The expression of CD44v6 was 44.3% and it was closely associated with depth of invasion and lymphatic permeation. There was no significant relationship between the expression of Mtl-MMP and CD44v6, but patients with expression of Mtl-MMP positive and CD44v6 negative had a high tendency of lymph node metastasis and poor prognosis. We conclude that the expression of Mtl-MMP and CD44v6 may be a significant indicator of EMR in superficial esophageal carcinoma.
Background : In recent years, research has been conducted on the sentinel lymph node (SN) in relation to diverse forms of cancer. In addition, many multicentral clinical trials on breast cancer are currently in progress in many parts of the world. With respect to gastrointestinal malignancy, research has been started at numerous institutions, primarily in Japan. Yet it is still not clear whether the concept of the sentinel lymph node can be established. In the present study, therefore, a comparative investigation was made of the distribution of cases with actual metastatic lymph nodes among patients with gastric cancer in order to see if the concept can be established. Methods : Radioisotope (RI) was injected preoperatively into patients diagnosed with early gastric cancer and the sentinel lymph node was detected postoperatively. SN cases were defined as ones in which the lymph node RI magnitude was 0.02% ID or greater. A comparison was made between the distributions of SN and of metastatic lymph nodes (MN) in cases of early gastric cancer that had been excised. Results : The SN could be detected in 40 of 41 cases, and 35 of these cases could be diagnosed as pathological early cancer. However although no metastasis was found in the first lymph node group, metastasis was positive in the second lymph node group for both the MN group and SN group ; the positive cases appeared at approximately equal frequency for these groups. According to the N-category of the Japanese classification of gastric carcinoma and the lymphatic basin, tiwas found that the distributions of the MN group and SN group were roughly equal statistically. Conclusion : The distribution of cancer cells and RI in lymph nodes was roughly equal. Since the possibility that the true SN is present in lymph nodes detected by RI is high, it is indirectly related to the background of the SN concept in gastric cancer.
In order to elucidate the role of transforming growth factor β1 (TGF-β1) in gastric cancer tissue, the influence of TGF-β1 produced by tumor cells on lymphocytes or stroma cells was investigated. Cancer cell strains taken from gastric cancer tissue were used to clarify TGF-β1 production by gastric cancer cells.Measurements by the ELISA method of TGF-β1 production volume in culture supernatant indicated that TGF-β1 of high NUGC-2 is produced. In addition, the culture supernatant of cell strains was used to investigate apoptosis induction in various cells, and it was found that conspicuous apoptosis is induced in T cell and B cell strains and that the same results were obtained with recombinant TGF-β1. Next, the contribution of the caspase family, the apoptosis praxis molecules, was analyzed and it was found that caspase 1, 3, and 8 are predominant in culture supernatant, whereas caspase 3 and 9 are predominant in recombinant TGF-β1. These results suggest that the humoral factors produced by gastric cancer cells, including TGF-β1, induce apoptosis in T and B lymphocytes by activating caspase, and thus could cause a reduction in tumor immunity.
Purpose:The purpose of the present study was to elucidate the significance of the Th1/Th2 balance of Tc1 activity before and after surgery in patients with advanced colon cancer. Subjects :The subjects were 30 patients with advanced colon cancer. There were 10 Dukes' B cases, 10 Dukes' C cases, and 10 Dukes' D cases. In addition, 10 healthy subjects were used for reference as a control group. Results :Conclusion : Comparison of the Dukes'B cases with the controls showed that Th1, Th2, and Tc1 activity were all increased before surgery, and no changes were observed after surgery. Based on the percentage change between before and after surgery, the Th1/Th2 balance had improved postoperatively. Suppression of the Th1/Th2 balance was observed in the Dukes' C cases at least at 1 month postoperatively. However, the levels of Tcl activity were higher than the controls both preoperatively and postoperatively. Conclusion The percentage change after surgery showed postoperative improvement of the Th1/Th2 balance in th Dukes' B cases, and there appeared to be a state in which Tc1 activity was being effetively utilized. Posoperative suppression of the Th1/Th2 balance was observed in the Dukes' C cases, sugesting that it may not have improved. However, since Tc1 activity was higher than in the controls both preoperatively and postoperatively, it appeared to be important to improve the Th1/Th2 balance and bring Tc1 activity to a more beneficial condition by immunotherapy methods, beginning in the early postoertive period.
The bulk of renal transplants in Japan are cases of living related transplantation in adults. Nevertheless, for a variety of reasons, renal transplantation from pediatric donors has not been actively pursued and there has been virtually no fundamental investigation pertaining to pediatric renal transplants. In the present study, we investigated the characteristics of ischemia reperfusion injury to the immature kidney. The animals used in experiments were female Sprague-Dawley rats weighing 250 g or 300 g, used as adult rats, and Sprague-Dawley rats 2 weeks old, used as neonate rats. First the right kidney was excised and then the left renal artery and vein were clamped for 1 or 2 hrs. Survival rates 24 and 48 hrs after reperfusion were measured, as were serum BUN, creatinine and TNF-α. Expression of TNF-α mRNA in kidney, small intestine, liver, lung and spleen were also measured. In the histological examination, DNA synthetic activity was investigated using hematoxylin-eosin staining and the bromodeoxyuridine (BrdU) labeling index. 24 hrs after 1-hr clamping, no significant difference in survival rate could be noted between the adult group and neonate group. On the other hand, 24 hrs after 2-hr clamping, a statistically significant difference was recognized between the two groups, with the survival rate at 78.6% for the adult group but only 16.7% for the neonate group. Whereas the survival rate 48 hrs after 2-hr clamping was 27.3% for the adult group, it was only 7% for the neonate group. The survival rate dropped sharply for both groups but no significant difference was recognized. Serum BUN and creatinine values increased in both groups but there was no significant difference. TNF-α in serum and tissue increased conspicuously only in the neonate group. In both groups, the BrdU labeling index increased more in rats undergoing ischemia reperfusion than in rats undergoing kidney excision alone. The results indicate that in terms of survival rate and TNF-α, the neoate group as donor is somewhat inferior to the adult group. However, there are no differences between the two groups in serum BUN and creatinine. Because DNA synthetic activity is higher in the neonate group, it is believed that the group could serve amply as transplant donor if postoperative regeneration can be skillfully induced.
In 1968 Steichen described a method of anastomosis called “functional end-to-end anastomosis” in which a linear anastomosis device and linear suture device were used to create a side-to-side anastomosis anatomically. We assessed the usefulness of a 100 mm linear stapler to perform functional end-to-end anastomosis during open surgery in 153 cases of advanced colon cancer. There have already been several reports on this technique, our own experience shed light on the following problems and points concerning the technique which have not been reported previously. First, the stump at the blind end must be buried with purse-string sutures, because the blind end on the proximal side in particular is exposed to the greatest pressure. Second, in left hemicolectomies the anastomotic portion often lies over the ligament of Treitz, and by raising it with 2-3 sutures on the gastric side, the anastomotic portion comes to rest in a more physiological position. Third, in sigmoidectomies, if the cutter is fired with the inverted opposite antimesenteric sides turned inward as in the conventional method, the anastomosis sometimes comes to lie immediately to the left of the aorta, whereas if the cutter is fired with the inverted opposite anti-mesenteric sides turned outward, the anastomosis often comes to rest in a more physiological position. The duration of the anastomosis procedure was approximately 5 to 8 minutes, there were no particularly major complications. This is a very useful method not only in gastrointestinal surgery, but in other disciplines as well.