Fifty cases of primary gastric lymphoma treated at Tenri Hospital between 1975 and 1992 were reviewed retrospectively. Histopathologically they were classified according to the Working Formulation into three groups: low grade 3 cases, intermediate grade 42 of which 34 were diffuse large cell and high grade 5. Their clinical stages according to the Ann Arbor staging system were as follows; Stage I 15 cases, Stage II 17, Stage III 5 and Stage IV 13. Twelve variables were tested by univariate analysis for prognosis. Significant prognostic factors were clinical stage, tumor depth to the gastric wall, regional lymph node involvement, macroscopic finding of tumor shape and surgical resectability. Important variables were tested by using a multiple regression, the 5 most significant variable being curative surgical resection. The year survival after curative resection was 93.8% and 25.2% for other patients (p<0.001). In the patients with Stage II-disease, the greater the ‘N-number’ of regional lymph node involvement according to the General Rules for the Gastric Cancer Study was, the lower the survival rate was due to the difficulty for curative resection (p<0.05). The same curative resection is nessessary for gastric lymphoma as for gastric cancer. In the patients with Stage III or IV disease, higher survival rate was achieved in the gastrectomy group than the others. In conclusion, an aggressive surgical intervention is warranted in the treatment of gastric lymphoma of any stage.
We examined the rhythm of weight velocity in eight patients with Crohn's disease. In this paper we used the spline smoothing technique to study the cycle in the weight increment velocity curves derived from individual data during nutritional therapy. As a result of the weight measurement at four-day intervals, an infradian rhythm with the average cycle of 9.6 ± 0.7 was recognized in all of the subjects in terms of the weight increment velocity. This rhythm was especially conspicuous in three adolescent patients with serious nutritional lesion. The cycle of the rhythm was unaffected by any of the following factors : energy intake, contents of nutritional therapy, medical examination during the period. Our findings of a common cycle in the process of convalescence from a low nutritious stage in patients with Crohn's disease suggest that, in others as well, the weight increment velocity might have an infradian rhythm with a kind of inherent periodicity.
Transjugular intrahepatic portosystemic shunt (TIPS) using an 8-mm Gianturco-Rösch Z stent was performed in 10 patients with liver cirrhosis admitted due to ruptured gastroesophageal varices. The treatment was successful in 9 patients, and the portal pressure decreased form 25 mmHg to 17 mmHg immediately after TIPS and to 15 mmHg 2 weeks after TIPS. The patency of the shunt was maintained adequately in the patients examined 3 months after TIPS. Endoscopy 1 month after TIPS showed improvements in the gastroesophageal varices in all patients. Hemobilia and intraperitoneal bleeding were observed in 1 patient each during procedure. Transient jaundice was observed in 2 and increase in the blood ammonia level were noted in 3 (one of whom had hepatic encephalopathy) postoperatively. All these complications could be treated easily. TIPS which brings about an immediate marked reduction in the portal pressure appears to be promising as a new treatment for portal hypertension.
Using the Colloid silver staining technique to reveal AgNOR and immunostaining for anti-PCNA monoclonal antibody, 23 resected specimens with hepatocellular carcinoma (HCC, ≤3.5cm in diameter) were examined. These cases were divided into two groups ; Group A [9 cases without vascular invasion and a satellite nodule] and Group B [14 cases with satellite nodules]. Comparison of AgNOR score, the morphological features of AgNOR (the area and roundness factor of AgNOR) and PCNA labeling index between Group A and Group B was made by a image analyzer (SP-500). The AgNOR scores and PCNA labeling indices of HCCs in Group B were significantly higher than those of HCCs in Group A. And a close correlation was shown between AgNOR score and PCNA labeling index. Further more, the area, form, and distribution of AgNORs within the nucleus were also different in the two study groups. In Group A, many AgNORs were regular and medium-sized brown dots (AgNOR-roundness factor ; ≥80%, AgNOR-area ; 1.5 ?? 4.5μm2). But in Group B, AgNORs showed marked variation in size and form. These results suggest that HCCs with multiple, smaller, irregular, and widely dispersed AgNOR in combination with high AgNOR scores have a more aggressive potential. The morphological features of AgNOR may be useful indicators for evaluating the proliferative activity of HCC.
We evaluated the diagnostic significance of blood flow pattern and velocity in hepatic tumors detected by color doppler ultrasonography. Fiftyseven patients with hepatocellular carcinoma (HCC) and 12 patients with hepatic hemangioma (HEM) were studied with ultrasonographic apparatus equipped with color doppler system (Toshiba SSA-270A, 3.75MHz sector scanner). Furthermore 12 patients with HCC were studied repeatedly after transcatheter arterial embolization (TAE) and/or percutaneous ethanol injection (PEI). Blood flow was measurable in 2 of 12 patients with HEM (17%). Pulsatile flow with low speed (7 cm/sec) and low amplitude was detected in one patient, and continuous flow with low speed (5 cm/sec) in the other. Blood flow was measurable in 43 of 57 patients with HCC (75%). The detection rate of blood flow in HCC was significantly higher than in HEM. Pulsatile flow was detectable in 42 of 43 patients (98%). Average maximum velocity of pulsatile flow was over 40cm/sec. Analysis of blood flow after treatment provided us useful information on the effect of treatment. In conclusion, analysis of blood flow in hepatic tumors on US with color doppler system may provide useful information on differential diagnosis between HCC and HEM, the assessment of the therapeutic effect of TAE or PEI, whether additional treatment is required or not, and when it should be done if required.
The effects of bilateral truncal vagotomy on cholecystokinin (CCK) release and pancreatic hypersecretion produced by bile and pancreatic juice (BPJ) diversion were examined in conscious rats. In addition, the effect of exogenous administration of CCK-8 (100 pmol/kg/h) on pancreatic secretion were compared in rats with and without vagotomy. Rats were prepared with external bile and pancreatic juice fistulae and the experiment was conducted on the 4th postoperative day. Basal pancreatic secretion was not affected by vagotomy. CCK release produced by bile and pancreatic juice diversion was enhanced, whereas protein secretion in response to high plasma CCK was inhibited by vagotomy. Pancreatic secretion stimulated by intravenous infusion of 100 pmol/kg/h of CCK-8 was also inhibited by vagotomy. These results proposed that vagal nerve is mandatory for the full response of pancreatic exocrine secretion to circulating CCK.
Ultrasound angiography (USAG), sonographic imaging of the blood flow in an organ or tissue obtained by carbon dioxide infusion into the supplying artery, was performed on 28 pancreatic nodular lesions less than 3 cm in diameter. The hemodynamics of tumors observed with USAG were divided into three groups : hypovascular, isovascular, and hypervascular, compared with the adjacent pancreatic tissue. Most of hypovascular nodules were duct cell carcinoma (sensitivity 94.1%, specificity 90.4%), while isovascular lesion was the characteristic of inflammatory masses (sensitivity 100%, specificity 95.8%). Hypervascular cases included all of the mucin producing tumors and islet cell tumors but only one case of duct cell carcinoma. So you can almost exclude duct cell carcinoma as an diagnosis in vascular rich tumors (negative predictive value 83.3%). These results were compared with those on conventional x-ray angiograms and incremental CT scans. Ultrasound angiography enabled us to detect more slight differences of tumor vascularity than the other modalities. Thus we conclude that USAG can be a useful diagnostic aid in small mass lesions of the pancreas.
US, EUS, color Doppler US, and color Doppler EUS were performed for five cases of pancreatic endocrine tumors. US was able to detect four cases of five tumors (80%), but could not sufficiently evaluate the internal echo. Color Doppler US was able to reveal the blood flows inside in only one case (25%). EUS was able to detect clearly all five cases (100%), and color Doppler EUS was able to reveal a significant amount of the internal blood flow in all cases. Color Doppler EUS was reflected in hypervascular findings on angiogram and proliferating vascular findings on histology. Therefore, ultrasound, especially EUS was useful for diagnosing the location of the tumor and for evaluating the internal echo, whereas color Doppler EUS was useful for evaluating the vascularity of the tumors.