The tumor suppressor gene maspin inhibits invasion, metastasis, and angiogenesis of cancers. The expression of maspin is reported to correlate inversely with tumor progression or prognosis in breast and prostatic cancer. We examined the relationship between maspin expression and progression of 14 surgicallyresected esophageal, 33 gastric, and 36 colonic cancer cases. Maspin expression was measured immunohistochemically and classified as high or low. In esophageal cancer cases, the frequency of high maspin expression in normal epithelium, intraepithelial cancer, invasive cancer, and lymph node metastasis were all high at 100%, 100%, 93% and 100%, respectively. Whereas in cases of gastric cancer, the frequency of high maspin expression in glandular epithelium, intestinal metaplasia, early-stage cancer, advanced cancer, and lymph node metastasis was 0%, 100%, 85%, 89%, and 91 %, respectively. Finally, in cases of colonic cancer, high maspin expression in normal epithelium, adenoma, early-stage cancer, advanced cancer, and lymph node metastasis was 0%, 100%, 63%, 70%, and 90%, respectively. Most squamous cell carcinomas of the esophagus showed diffuse expression of maspin, whereas gastric and colonic cancers, and especially well-differentiated adenocarcinoma, . tended to show heterogenous expression patterns. There was no inverse correlation found between maspin expression and tumor progression or metastasis in gastric and colonic cancers. The high levels of maspin expression observed both in primary and metastasic lesions of the three types of cancer suggest an important role of maspin expression in these tumors and the potential use of maspin as a tumor marker. Although an association has not yet been clearly demonstrated between maspin expression and tumor progression in gastric and colonic cancers due to the heterogenous pattern of maspin expression. maspin is considered a useful prognosticator of alimentary tract cancers and is expected to be applied as a new therapeutic strategy.

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The aim of this study was to estimate the magnitude of genetic factors involved in the pathogenesis of Class III malocclusion in Japanese patients. We investigated 311 index cases (112 male, 199 female ; mean age 23.7 years) with Class III malocclusion. A questionnaire was used to determine the occurrence of Class III malocclusion among relatives. There were no significant differences in 1) the occurrence of this disease in index cases and the occurrence rates between the affected fathers and mothers, or between the affected grandfathers and grandmothers (either maternal or paternal), 2) the occurrence of this disease in index cases and the occurrence of Class III malocclusion in 1 or both of the paternal or maternal grandparents, 3) the risk of developing Class III malocclusion in the risk of a case developing Class III malocclusion according to the occurrence of the condition among parents and grandparents. The sibling recurrence risk (K_s) obtained was 55.7% (95% confidence interval, 52.0-59.3), and the sibling recurrence risk ratio (A_s) was 18.8. The high sibling recurrence risk ratio supports a strong genetic background for Class III malocclusion in Japanese, and provides a basis for designing future genetic linkage studies.

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Measurement of the peak expiratory flow (PEF) is ideal for patients to perform at home for objective monitoring of chronic asthma. The level of eosinophil cationic protein (ECP) in induced sputum has been reported to be a reliable parameter of airway inflammation. Accordingly, we investigated the relationship between ECP level in induced sputum and management of asthma by the PEF zone system. Sixteen asthma outpatients were enrolled in this study which was performed over a 6 month period. PEF zones were determined from the personal-best weekly mean PEF value during the initial 3 months. During the next 3 months, the inhaled corticosteroid (ICS) dose was reduced by 50% and the rate required to maintain the PEF green zone set in the first 3 months was calculated. The eosinophil count and ECP level in induced sputum, as well as the serum ECP level, were measured 3 times throughout the study period. In the steroid group, there was a significant decrease in the PEF green zone maintenance rate, but no significant changes in the sputum eosinophil count, sputum ECP level and serum ECP level. There was no significant relationship between the PEF green zone maintenance rate and the sputum ECP level. Although the PEF green zone maintenance rate reflected the clinical response to ICS dose reduction, the ECP level (sputum or serum) was much less sensitive. This suggests that ECP may be of limited value for monitoring airway inflammation in patients with chronic stable asthma on anti-inflammatory therapy.

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A 69-year-old man with a right inguinal mass was admitted on January 23, 2002. He underwent an ileocecal excision for treatment of cecum cancer (pT3 N1 M0) in December 2000. The mass contained a cystic component and had a saccular tumor protruding from the inner wall. The operative findings revealed that the mass extruded from the external inguinal ring, and a modified Bassini's operation was performed on February 1, 2002. The cystic component was completely separated from the peritoneal cavity, and was found to contain high levels of CEA and CA19-9. Pathological examination revealed that this saccular tumor was an adenocarcinoma similar to that seen in cecum cancer. Saccular tumors originating from cecum cancer are very rare and the prognosis is usually poor. However, the prognosis for the case reported in this study was favorable, and recurrence was still not seen 33 months after surgery. The possibility of peritoneal metastasis should be considered in inguinal hernia patients with a history of intraperitoneal malignancy.

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A 67-year-old-man underwent distal gastrectomy with D2 lymph node dissection for gastric cancer in the lower body of the stomach in July 1998. Abdominal ultrasonography and computed tomography (CT) in July 1999 revealed a liver metastasis within the anterior segment of the right hepatic lobe. Partial resection of the affected lobe segment was performed in August 1999. Chemotherapy was administered in the outpatient clinic with intermittent hepatic arterial infusion of 5-FU for adjuvant chemotherapy. A chest CT scan in March 2002 revealed an abnormal lesion within the right lobe of the lung. CT guided percutaneous biopsy suggested metastasis from the gastric cancer due to histological similarities with the original adenocarcinoma. Thoracoscopic partial pulmonary resection was carried out in May 2002. A subsequent chest CT in January 2003 revealed metastasis in the mediastinal lymph node. Consequently, the patient was started on combination chemotherapy of TS-1 plus CPT 11. Paclitaxel chemotherapy was included in later courses of treatment following discovery of multiple bilateral lung metastatic lesions by chest CT scan in October 2003. This therapy markedly reduced the size of the mediastinal lymph node and multiple lung metastases after 4 courses of paclitaxel. The patient is currently well with a high quality of life. This is only the second case reported in Japan of complete surgical resection of gastric carcinoma with resolution of metachronous liver and lung metastases.

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