Proximal gastrectomy and jejunal pouch interposition: evaluation of postoperative symptoms and gastrointestinal hormone secretion.

Reflux esophagitis, dumping syndrome and malnutrition are included in the postgastrectomy complications. To prevent or minimize such sequelae, proximal gastrectomy with an interposed jejunal pouch has been advocated as an organ-preserving surgical strategy to improve quality of life for the patients. Proximal gastrectomy was performed in 44 patients with tumors in the upper third of the stomach; 21 had reconstruction using jejunal pouch interposition between the esophagus and the remnant stomach (JP group), while 23 had reconstruction by esophagogastrostomy (EG group). Re-construction method was selected by each patient on the basis of the informed consent. Thirty-five patients had early gastric cancer. Postoperative courses of patients were reviewed in terms of symptoms, weight maintenance, nutritional status, blood chemistry values, endoscopic findings, and radiographic appearances after a barium meal. Concentrations of gastrointestinal hormones were measured in response to a test meal. The JP procedure permitted increased dietary volume. The JP group showed fewer severe postoperative symptoms than the EG group. After operation, all patients examined in both groups showed hypergastrinemia and all patients examined in the JP group showed hypersecretinemia. In proximal gastrectomy, the JP procedure improved patient's post-operative quality of life.

A case of duodenal involvement of multiple myeloma imaged by positron emission tomography with 18F-fluorodeoxyglucose.

A 61-year-old woman had been treated for multiple myeloma for 4 years when she developed abdominal pain. Ultrasonography and computed tomography revealed a tumor in the abdomen. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) showed increased FDG uptake in the tumor. In previous bone marrow lesions, which were in clinical remission after chemotherapy and radiotherapy, abnormal FDG uptake was not recognized. Pathological examination after surgery revealed the tumor to be a plasmacytoma of the duodenum. Plasmacytoma of the duodenum is rare but can be seen during the clinical course of multiple myeloma. A few reports have described FDG PET findings of plasmacytoma. Those previous reports and our present case suggest a potential value of FDG PET in the evaluation of multiple myeloma.

[Effects of body control and attention on body sway induced by a tilting room].

The purpose of this study was to examine the effects of body control and attention on body sway that was induced by a "tilting room". With an initial instruction, 18 subjects were divided into two groups: target and body attention groups, and then stood on a stabilometer in a room that tilted forwardly. Body sway that was induced by the tilting room was measured with the stabilometer. During the training session, subjects received Dohsa training (Naruse, 1973) in order to control their body movement. Analyses indicated the following: (1) Subjects swayed in the same direction as tilting of the room; (2) No difference in the body sway was found for the two groups before training; and (3) After training, subjects increased the controllable area on the stabilometer and learned to use their bodily sensation better. Subjects in the target attention group had a greater increase in body sway than the other group. These results suggest that adult flexibility appeared in an ecological situation where conflicting information was received through visual and bodily sensation.

[The effect of alpha-glucosidase inhibitor on burning epigastralgia in dumping syndrome: a case report].

Dumping syndrome results from a rapid passage of carbohydrate in the small intestine after gastric surgery. A 50-year-old man developed the syndrome after surgery for peptic ulcer. He often complained of burning epigastralgia after meals. Various methods of treatment had only a limited effect. Acarbose, alpha-glucosidase inhibitor, suppresses the breakdown of carbohydrates in the small intestine and consequently reduced osmolarity. The patient had a dramatic improvement in the dumping syndrome including epigastralgia, diarrhea and perspiration with an administration of acarbose 50 mg. There was no intractable side effect. Preprandial administration of acarbose is a reasonable treatment in the case of dumping syndrome.

Localization of Epstein-Barr virus in lymph node metastasis with nasopharyngeal carcinoma.

Epstein-Barr virus DNA was detected in 3 cases of lymph node metastasis with nasopharyngeal carcinoma, using in situ hybridization. EBV-DNA was demonstrated on the nuclei of the neoplastic cells, and was absent on those of lymphocytes. Localization of EBV-DNA in neoplastic cells was confirmed by the double-labeling method combining in situ hybridization and immunocytochemistry. Direct evidence of the presence of EBV-DNA in malignant epithelial cells from lymph node metastasis with nasopharyngeal carcinoma was clearly demonstrated in this study.

Transcutaneous intracordal silicon injection for unilateral vocal cord paralysis.

Unilateral recurrent laryngeal nerve paralysis causes the vocal cord to atrophy, leading to glottic incompetence. The voice is characterized by hoarseness, breathlessness, rapid air escape, ineffective cough and aspiration. Traditional treatments of unilateral vocal cord paralysis include intracordal injection, laryngeal framework surgery, and laryngeal reinnervation for medialization of the vocal cord. In this paper we report on a new technique of transcutaneous intracordal silicon injection in which the injection is made through the thyroid lamina under local anesthesia monitoring fiberscopy. We performed this procedure on 30 patients with unilateral vocal cord paralysis and later evaluated their post-operative voice. The silicon injection resulted in improvement of vocal quality, favorable clearance of sputum, and aspiration control. We found that, since it can be performed under local anesthesia without hospitalization, transcutaneous intracordal silicon injection should be performed as a therapy for treating unilateral vocal cord paralysis.

[Expression of human papillomavirus (HPV) gene in HPV-positive laryngeal tumors and activity of the HPV long control region in cultured normal laryngeal epithelial cells].

Expression of the human papillomavirus (HPV) gene was examined in HPV-positive laryngeal tumors. Moreover, the activity of the HPV long control region (LCR) was tested in cultured laryngeal epithelial cells. HPV-11 early genes were heterogeneously expressed in adult laryngeal papillomas. We found one laryngeal carcinoma case in whom the HPV-16 transforming genes, E6 and E7, were expressed. Both HPV-11 and -16 LCRs were active in cultured laryngeal epithelial cells from vocal cords. These results suggest that laryngeal epithelial and tumor cells are target cells for HPV gene expression.

Quantitative analysis of platelet-activating factor in rat brain.

Age-related decrease of the platelet-activating factor (PAF) content in rat brain was shown by a convenient method consisting of solid extraction of lipids with a Sep-Pak C-18 cartridge, lipid separation by HPLC and bioassay on rabbit platelets. This method was sufficiently sensitive to allow measurement of PAF in a single brain, and the recovery of PAF was quite high throughout the procedure.

[Detection of human papillomavirus DNA in hypopharyngeal carcinoma].

The detection of human papillomavirus type-16 and -6b was performed in 28 cases of hypopharyngeal squamous cell carcinomas by polymerase chain reaction. Human papillomavirus (HPV) DNAs extracted from paraffin-embedded metastatic lymph node tissue were used for polymerase chain reaction with amplification of the E1 region of HPV genotype 6b and the E6 region of HPV genotype 16. HPV type 6b sequences were detected in three cases; positive amplification of type 16 sequences was also seen in three cases. These findings suggest that HPV infection might be closely associated with the development of some hypopharyngeal carcinomas as it is with laryngeal and uterine cervical carcinogenesis.

Detection of Epstein-Barr virus DNA in formalin-fixed paraffin-embedded tissue of nasopharyngeal carcinoma using polymerase chain reaction and in situ hybridization.

The polymerase chain reaction method for amplification of DNA in formalin-fixed, paraffin-embedded tissue sections was used to detect Epstein-Barr virus DNA in nasopharyngeal carcinomas from Japanese patients. Thirty-one cases of nasopharyngeal carcinoma and 8 cases of lymph node metastasis of nasopharyngeal carcinoma were studied. Detection rates of Epstein-Barr virus in various types of nasopharyngeal carcinoma according to the World Health Organization classification were as follows: 10 of 10 undifferentiated carcinomas, 8 of 13 nonkeratinizing carcinomas, and 5 of 7 keratinizing carcinomas. Eight lymph node metastases, for which the primary was positive for Epstein-Barr virus, also contained Epstein-Barr virus DNA. By in situ hybridization using a biotinylated Epstein-Barr virus probe, it was clearly demonstrated that Epstein-Barr virus DNA was localized in the nuclei of the neoplastic cells. The clinical features of nasopharyngeal carcinoma with or without Epstein-Barr virus were not different. These results demonstrate that nasopharyngeal carcinoma in Japanese patients is closely associated with Epstein-Barr virus infection, similar to nasopharyngeal carcinoma of other endemic and nonendemic areas.

Effects of attention and expectation on tickle sensation.

The purpose of the present study was to examine the changes of the tickle sensation reflected in effects of the direction of attention to one's own body (Exp. 1) and the expectation of the experimenter's gestures (Exp. 2). In Exp. 1, for 15 subjects, when tickled on their own foot soles, the tickle sensation was not significantly changed by attending to the stimulus and to one's own sole. These results suggested the importance of instructions. In Exp. 2, 6 subjects were tickled and were required to report their experience while they looked at the experimenter's gestures and were tickled. Although the subjects' stimulations were unaffected by looking at the gestures, the tactual stimulus elicited a tickle sensation. From these results, quantitative and qualitative differences in subjects' tickle sensation may be identified.

Detection of human papillomavirus DNA in laryngeal squamous cell carcinomas by polymerase chain reaction.

The presence of human papillomavirus genomes-16 and -6b in metastatic cervical lymph nodes was examined in 34 cases of laryngeal carcinomas by means of polymerase chain reaction, which had been fixed in formalin and embedded in paraffin. Human papillomavirus DNAs extracted from paraffin-embedded tumor tissues were used for polymerase chain reaction with amplification of the E6 region of human papillomavirus genome-16 and the E1 region of human papillomavirus genome-6b. Human papillomavirus genome-16 sequences were positively amplified in six (17.6%) metastatic tumors; -6b sequence was positively amplified in one (2.9%) metastatic tumor. Laryngeal carcinomas of glottic origin showed high human papillomavirus genome-16 DNA-positive rates (4 of 9 cases, 44.4%) compared to those of other sites. These results suggest that human papillomavirus genome-16 infection might be closely associated with the development of some laryngeal squamous cell carcinomas of glottic origin similar to uterine cervical carcino-genesis.

Detection of Epstein-Barr virus DNA in Reed-Sternberg cells of Hodgkin's disease using the polymerase chain reaction and in situ hybridization.

Thirty-one cases of Hodgkin's disease were examined for the occurrence of Epstein-Barr virus (EBV) genome by using the polymerase chain reaction (PCR) of DNA in formalin-fixed paraffin-embedded tissues and in situ hybridization technique. The cases were subdivided into 17 cases of nodular sclerosis (NS), nine cases of mixed cellularity (MC), four cases of lymphocyte predominance (LP), and one case of lymphocyte depletion (LD). EBV DNA was detected in eight cases including four cases of NS, three cases of MC and one case of LP. The sensitivity of PCR was higher than that of Southern blot hybridization of DNA from fresh frozen tissue, because Southern blot hybridization using the BamHI-W fragment of EBV detected virus DNA only in two of three cases which were positive by PCR. The results of in situ hybridization studies confirmed that EBV genome was localized within the nuclei of Reed-Sternberg (RS) cells and their mononuclear variants. Furthermore, double-labeling studies combining in situ hybridization and immunocytochemistry using CD30 (BerH2) and CD15 (LeuM1) as markers of RS cells, as well as pan B-marker (L26) and pan T-marker, CD45RO (UCHL1), were performed to demonstrate the phenotype of EBV DNA-positive cells, confirming that EBV DNA was present in RS cells but not in lymphocytes. The results of this study indicate a significant association between EBV and some cases of Hodgkin's disease.

[Plasma and tumor gastrin in patients with primary hyperparathyroidism].

It is well known that primary hyperparathyroidism is often associated with peptic ulcer. The purpose of this study is to confirm the relationship between the gastrin-levels before and after parathyroidectomy in fourteen patients with primary hyperparathyroidism, and to determine the localization of gastrin in the surgically resected parathyroid tumor. The results obtained were as follows: 1) Three patients had peptic ulcer (gastric ulcer and duodenal ulcer), the incidence being 21%. 2) The basal serum gastrin levels were 123.0% +/- 68.1 pg/ml before operation and decreased to 90.2 +/- 44.5 pg/ml after operation. In the 3 patients with slightly elevated gastrin levels, the mean level before operation was 209.1 +/- 61.2 pg/ml. The gastrin level decreased to 116.4 +/- 62.0 pg/ml after operation. 3) Gastrin immunoreactivity was detected in 10 out of 14 tumors and its localization was at the periphery of tumor cells. From these results, we conclude that extragastric gastrin secretion from parathyroid tumors may be one of the cause of peptic ulcer in patients with primary hyperparathyroidism.

Heart rate and metabolic responses to participation in golf.

Five healthy middle-aged men were asked to perform 18 holes of golf. Heart rate was measured throughout the play, and blood samples were compared before and after play. Oxygen uptake during play was estimated from their heart rate response during a treadmill-walking test. Mean heart rate was 108 (range 92-121) beats/min, which corresponded to 38 (range 35-41) %VO2max. Caloric cost of golf is 4-6 kcal/min and total energy expenditure was estimated more than 960 kcal during 18 holes. Blood glucose decreased and FFA increased following 18 holes of play. Golfing seems to be a suitable sport for middle-aged and elderly persons to enhance energy expenditure.

[A case of small cell carcinoma of the esophagus].

The case of a 51-year-old man, complaining of a sense of pressure on his chest, is reported. Tests led to a diagnosis of a cancer in the midesophagus and a subtotal esophagectomy was performed. The tumor was found to be a protruded type, 8.5 X 7.0 cm in size. A histologic diagnosis revealed it to be a small cell anaplastic carcinoma. The tumor cells were found negative in a Grimelius staining and did not contain hormones such as ACTH. Some cytokeratins, however, were detected by an immunohistochemical examination, Cancer invasion into the adventitia was seen, though no lymph node metastasis or a distant metastasis was shown. Six months after operation, a recurrence in the mediastinum and in the distant lymph nodes was found. Chemotherapy and irradiation were found to be useful, and the postoperative survival period was 25 months.

[Surgical problems of Kock's continent ileostomy in patients with ulcerative colitis].

Postoperative problems including pathophysiology at follow up were investigated in Kock's continent ileostomy in patients with ulcerative colitis. The results obtained were as follows: Though postoperative complication was found in all 4 cases, it was improved in 3 of them by conservative or surgical treatment. Troublesome skin irritation, such as erosion or ulcer, was not found in any case. The patients empty the reservoir when it is convenient and intestinal discharge was 1 to 4 times per day and these results were proved from the studies of the pressure and capacity in the Kock's ileostomy. Various plasma amino acids in patients with Kock's ileostomy showed almost similar levels to those of the normal subjects. Bacteriological examination in the stool in Kock's ileostomy also revealed almost similar results to those of the normal subjects. From these results, we conclude that Kock's continent ileostomy should be more widely performed for the patients with ulcerative colitis when ileostomy is required.

[The concentration of cefmenoxime after intravenous drip infusion in digestive organs and exudates from abdominal and thoracic cavities in human].

We investigated the concentrations of cefmenoxime (CMX) after administration of 2 g of CMX, in the tissues resected during operation 2 hours after the beginning of intravenous drip infusion, and in the exudates from abdominal or thoracic cavities in the postoperative period. The results were as follows: The highest tissue concentration of CMX was found in the liver (59.0 +/- 20.3 micrograms/g), and the lowest was in the pancreas (13.9 +/- 8.1 micrograms/g). The concentrations of CMX in the tissues were in order of liver much greater than colon = esophagus = stomach greater than pancreas. The peak concentration of CMX in exudate from thoracic cavity was 15.6 +/- 10.1 micrograms/ml, and was observed 2 hours after the beginning of intravenous drip infusion, later than that in serum. Furthermore, the concentration of the exudate was maintained to a reasonable extent for 5 hours. The concentrations of CMX in both tissues and exudates were enough to inhibit the growth of many kinds of bacteria isolated from abdominal infections.