Internal magnetic field measurements of translated and merged field-reversed configuration plasmas in the FAT-CM device.

Field-reversed configuration (FRC) Amplification via Translation-Collisional Merging (FAT-CM) experiments have recently commenced to study physics phenomena of colliding and merged FRC plasma states. Two independently formed FRCs are translated into the confinement region of the FAT-CM device, collided near the mid-plane of the device with a relative speed of up to ∼400 km/s, and a final merged FRC plasma state is achieved. To measure internal magnetic field profiles of the translated and merged FRC plasmas as well as to understand its collisional-merging process, an internal magnetic probe array, developed by TAE Technologies, has been installed in the mid-plane of the FAT-CM device. Initial magnetic field measurements indicate that both the translated and the merged FRC plasma states exhibit a clear field-reversed structure, which is qualitatively in good agreement with 2D MHD simulation. It is found and verified that a sufficient mirror field in the confinement region is required for colliding FRCs to be fully merged into a single FRC plasma state.

A new embryologic hypothesis of annular pancreas.

Annular pancreas is a developmental anomaly of the pancreas. There are two major hypotheses concerning development of the annular pancreas from the ventral pancreatic anlage; adhesion of the right ventral anlage to the duodenal wall (Lecco's theory), and persistence of the left ventral anlage (Baldwin's theory) reported in 1910, but each theory has some problems and can account for only a few types of annular pancreas. We report a new embryologic hypothesis of annular pancreas which can account for the developmental mechanism of three types of arrangement of annular ducts. The tip of the left ventral anlage adheres to the duodenum and stretches to form a ring. Whether the tip is proximal or distal to the bile duct creates several arrangements of the annular duct.

[Clinicopathologic study on chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct].

We studied the clinicopathologic features of 13 cases of chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct (MPD). It occurs frequently in relatively elder men. Diffuse irregular narrowing of the MPD and stenosis of the common bile duct on ERCP, and swelling of the pancreas on US/CT were detected in all cases. An autoimmune mechanism might be involved in the etiology at least in 5 patients with hypergammaglobulinemia and positive autoantibodies. Surgical therapy was performed in 8 patients and 3 patients were treated with steroids. No patients showed recurrence of pancreatitis. Histologic findings were characterized by diffuse lymphoplasmacytic infiltration with marked interstitial fibrosis in the pancreas, obliterated phlebitis of the pancreatic veins. Similar inflammatory process involved the bile duct and the gallbladder. These histologic findings were similar to those of multifocal fibrosclerosis. Chronic pancreatitis with diffuse irregular narrowing of the MPD is overlapped with autoimmune pancreatitis in many cases, but may be a variant of multifocal fibrosclerosis involving the pancreas in some cases.

Immunohistochemical localization of pancreatic secretory trypsin inhibitor in malignant pancreatic endocrine tumors.

Differentiation of benign from malignant pancreatic endocrine tumors by existing clinical, biochemical, histologic, and cytologic criteria is difficult. We immunohistochemically localized pancreatic secretory trypsin inhibitor (PSTI) in 28 pancreatic endocrine tumors (13 benign, 15 malignant). PSTI-immunoreactive cells were detected in nine endocrine tumors. Immunoreactivity in these tumors was detected in nearly all tumor cells in five cases, scattered cells in two cases, and a few cells in two cases. All positive cases were malignant, and eight were equal to or larger than 10 cm. Serum concentrations of PSTI were markedly elevated in the two patients so tested. PSTI may be a specific immunohistochemical marker for malignant pancreatic endocrine tumors.

Patency of the accessory pancreatic duct in relation to its course and shape: a dye-injection endoscopic retrograde pancreatography study.

OBJECTIVE: The accessory pancreatic duct (APD) exhibits several appearances on pancreatography. We examined the patency of the APD by dye-injection endoscopic retrograde pancreatography (ERP), and studied the relationship between patency and duct course and shape. METHODS: There were 213 patients with satisfactory imaging of the entire normal APD who also underwent dye-injection ERP. The length and maximum diameter of the APD and the length of the main pancreatic duct (MPD) from its orifice to the junction with the APD were measured. RESULTS: The caliber of the patent APD was 1.6 +/- 0.6 mm. This was significantly larger than the caliber (1.1 +/- 0.4 mm) of the nonpatent APD (p < 0.01). The length of the MPD from its orifice to the junction with the patent APD was 32.7 +/- 12.5 mm. This was significantly longer than the length to the junction with the nonpatent APD (22.5 +/- 8.1 mm) (p < 0.01). The APD was classified according to duct course: long type, intermediate type, short type, or ansa type. Patency was most common in the long type APD (74.5%). The terminal shape of the APD was also used to classify the ducts: stick type, branch type, saccular type, cudgel type, or spindle type. Patency was most frequently observed in the spindle and cudgel type ducts. CONCLUSIONS: Patency of the APD might be dependent on duct caliber, course, and terminal shape of the duct.

Characteristics of pancreatic carcinoma in the elderly.

CONCLUSION: Lymphogenous as well as hematogenous metastases were significantly less frequent in the elderly group of patients, although local invasion was comparable. Survival was comparable between both groups although palliative therapy alone was significantly more frequent in the elderly. BACKGROUND: The relative and absolute numbers of elderly patients continue to increase, as does the incidence of pancreatic carcinoma. To determine the optimal therapy for elderly patients with pancreatic carcinoma, we examined their clinicopathological features. METHODS: The clinical and histopathological features of pancreatic carcinoma in patients 70 yr of age or older (n = 89) were compared with those in patients aged 69 yr or less (n = 184). RESULTS: A total of 273 patients showed histologically tubular adenocarcinomas and their major variants. The male:female ratio peaked at 1:0.3 in patients under 49 yr old but gradually decreased to 1:1.2 in those aged over 80 yr. There were no significant differences between the two groups in the resectability, prognosis, location, or histology of the tumor. Hematogenous and lymphogenous metastases were detected at autopsy in 68 and 61% of patients old than 70, and in 82 and 80% of the younger group.

[Function of the accessory pancreatic duct in the pancreaticobiliary maljunction].

We examined the function of the accessory pancreatic duct (APD) in 56 cases of the pancreaticobiliary maljunction. APD existed in 11 of 26 cases of the congenital choledochal cyst. The maximal diameter of APD was over 2 mm in 5 cases. Patency of APD was detected in 5 of 9 cases examined by dye-injection endoscopic retrograde pancreatography (ERP). APD existed in 15 of 30 cases of the pancreaticobiliary maljunction without biliary dilatation, and all APDs were less 2 mm in diameter. By dye-injection ERP, APD was patent in 4 of 13 cases. There was no significant relationship between patency of APD and associated biliary carcinoma in the cases of the pancreaticobiliary maljunction, but 5 cases of the congenital choledochal cyst with APD bigger than 2 mm in diameter had no biliary carcinoma. Amylase level of the bile in cases of the pancreaticobiliary maljunction with patent APD was frequently lower than that of cases with nonpatent APD. It is suggested that in cases of the pancreaticobiliary maljunction with patent APD, the incidence of carcinogenesis of the biliary tract might be lower, as the reflux of the pancreatic juice to the bile duct might be reduced by the flow of pancreatic juice from the upper dorsal pancreatic duct into the duodenum via the minor duodenal papilla.

Relationship between progression of gastric mucosal atrophy and Helicobacter pylori infection: retrospective long-term endoscopic follow-up study.

A retrospective long-term endoscopic follow-up study was designed to examine atrophic changes in the gastric mucosa over time in Helicobacter pylori-positive patients. Over a period of 8-17 years (mean, 13.4 years) 22 subjects (5 men, 17 women, mean age, 55 years) without localized gastroduodenal lesions underwent serial endoscopic examinations and serological and microbiological assessments of H. pylori infection. The extent of atrophic mucosa in the gastric body was expressed using the Kimura-Takemoto classification of atrophic pattern. Atrophic patterns were unchanged over time in 7 H. pylori-seronegative and culture-negative subjects with normal stomach, and in 1 seropositive and culture-negative subject with severe atrophy. Seven of 10 H. pylori culture-positive subjects not including three with the O-3 pattern, i.e., open type atrophic pattern, exhibited a cephalad shift of atrophic pattern. The cumulative progression rates of atrophy in the culture-positive subjects excluding O-3 subjects, were 10% after 2 years, 20% after 4 years, 50% after 6 years, and 70% after 8 years. The increases in the extent of the atrophic area were discontinuous, in terms of age, in the H. pylori-positive individuals and occasionally advanced rapidly within periods of several years with no relation to age.

Treatment of T3 and T4 carcinomas of the gallbladder.

Forty-nine patients with T3 and T4 carcinoma of the gallbladder were treated by three different regimens. Group 1 consisted of 26 patients treated with combined resection alone; group 2 was twelve patients whose tumors had spread to the hepatoduodenal ligament treated with combined resection plus intraoperative radiation therapy; group 3 comprised eleven patients with nonresectable tumors treated with hyperthermia in combination with chemoradiation therapy (HCRT). The difference in the survival rates between group 1 and 2 were statistically significant (p < 0.001); however, the difference between group 2 and 3 was not significant. In group 1, there was a significant difference between patients with and without lymph node involvement in the 3-year survival rate (p < 0.01). Thus, the only patients without involvement of regional lymph nodes and the hepatoduodenal ligament have the best potential for long-term survival through aggressive surgical approaches. HCRT may provide an alternative palliation for patients with advanced carcinoma showing obstructive jaundice.

The influence of Helicobacter pylori infection on the progression of gastric mucosal atrophy and occurrence of gastric cancer.

AIM: To study the effects of Helicobacter pylori infection on the progression of gastric mucosal atrophy and the development of gastric cancer. PATIENTS AND METHODS: We investigated the extension of the atrophic area as assessed on the basis of the Kimura-Takemoto atrophic patterns and the development of gastric cancer in a selected sample of 64 patients who were endoscopically followed up for more than 3 years, and who showed H. pylori infection by culture at the start of the investigation and at some stages during the follow-up. RESULTS: No progression of atrophy was observed in 14 patients who were H. pylori-negative at the beginning of the follow-up, whereas various degrees of expansion of the atrophic area were found in 22% of 50 positive cases. Well differentiated mucosal cancer was diagnosed in four patients during the follow-up. These patients displayed moderate to severe atrophy. At the beginning of the follow-up, 50% of patients were H. pylori culture-positive, but all patients had H. pylori antibodies in their blood. CONCLUSIONS: The results support the view that H. pylori infection influences the development of atrophic gastritis and is related to the pathogenesis of gastric cancer.

An endoscopic study on relationship between Helicobacter pylori infection and endoscopic gastric ulcer scars.

A two-year endoscopic follow-up study of 45 gastric ulcer patients was conducted in order to ascertain the relationship between Helicobacter pylori infection, the transformation of ulcer scar patterns, and ulcer relapse during maintenance therapy. Endoscopic findings of gastric ulcer scar patterns, which established the quality of ulcer scars, were classified as follows: Sa, with a central depression, Sb, with a coarse regenerating mucosal pattern up to the center, and Sc, with a fine pattern. The proportion of ulcer relapses was 62% among 29 H. pylori-positive patients and 0% among 16 H. pylori-negative patients. In regard to the relationship between H. pylori infection and scar patterns, 94% of the H. pylori-negative patients displayed Sc scar patterns, while all the H. pylori-positive patients showed various scar patterns, ie, Sa in 38%, Sb in 28%, and Sc in 10%. Ulcer relapses in the H. pylori-positive cases were limited to the Sa and Sb groups (100% and 88%, respectively). In conclusion, our results indicate that H. pylori infection plays an important role in the transformation of the ulcer scar patterns which relate to ulcer relapse.

Annular pancreas associated with carcinoma in the dorsal part of pancreas divisum.

A carcinoma in the dorsal part of the pancreas divisum with an annular pancreas in the anterior part is reported. A 79-yr-old female was admitted in our hospital complaining of epigastralgia. Computed tomography (CT) and ultrasound (US) showed an irregular mass in the pancreatic body. A pancreatogram obtained through the major duodenal papilla demonstrated only the ventral pancreatic duct that encircled the duodenum. Contrast medium injected from the minor duodenal papilla showed Santorini's duct obstruction at the neck portion of the pancreas without communication with the ventral pancreatic duct. The patient died with liver metastases. Autopsy confirmed annular pancreas and a 6-cm tumor in the pancreatic body extending to the pancreatic head and pancreas divisum. Pancreatic carcinoma; histologically a moderately differentiated adenocarcinoma; originated from the dorsal part of pancreas divisum. To our knowledge this is the first report of pancreatic carcinoma associated with annular pancreas coexistent with pancreas divisum.

[Sequential MTX and 5-FU therapy of gastric cancer with systemic bone metastasis and disseminated intravascular coagulation].

UNLABELLED: Sequential therapy consisting of methotrexate (MTX) and 5-FU was performed together with the administration of heparin and FOY in 10 cases of gastric cancer with disseminated intravascular coagulation (DIC) causing systemic bone metastasis. The ages of the subjects ranged from 29 to 65 years (median: 49 years) with systemic bone metastasis and bone marrow carcinosis observed in all cases. Histological types consisted of 6 cases of poorly differentiated adenocarcinoma, 2 cases of signet-ring cell carcinoma, and one case each of mucocellular and tubular adenocarcinoma. Therapy consisted of intravenous injection of 30 mg-100 mg/m2 (one case, 20 mg) of MTX followed three hours later by intravenous injection of 600 mg/m2 of 5-FU weekly. Determination of DIC was made in accordance with the DIC diagnostic standards of the Ministry of Health and Welfare, and determination of tumor effectiveness was based on gastric cancer handling codes. RESULTS: PR was observed in 3 cases. Diffuse metastasis observed in the entire lung field disappeared in one case, while remarkable improvement was observed in systemic bone metastasis in scintigram findings for the other 2 cases. All 3 cases were able to be discharged. Reduction of DIC score and absence of pain were observed in 8 cases. Based on the above, aggressive implementation of this treatment method is suggested.

[CT findings of pseudomyxoma peritonei].

Four patients with pseudomyxoma peritonei were studied by computed tomography. CT images in all cases showed low density area simulating ascites in the peritoneal cavity. The low density area was due to gelatinous masses, which were proved by surgery or autopsy. The CT number of gelatinous masses was almost equal to that of water. Scalloping of liver and separated intestinal loops in the low density area were seen. One case had scattered calcifications in the low density area. The calcification in the low density area is a specific finding in pseudomyxoma peritonei.

[Clinical significance of the combined use of radiation therapy and hyperthermia].

Sixty-eight cases of cancer were treated by combined use of Thermotron RF-8 hyperthermia and radiotherapy, and 16 cases by combined use of hyperthermia and anti-cancer drug. The results of analysis of treatment are summarized as follows. Thermo-radiotherapy of shallow-seated tumor: Shallow-seated tumor at a depth of 7 cm or less from the skin surface was present in 43 cases. Most of these were metastatic tumors of lymph node, chest wall and abdominal wall. Pathological findings and primary effect; The effect of treatment was evaluable in 40 cases, the breakdown being as follows: CR 21 cases 53%, PR 13 cases 40%, and NR 3 cases 7%. The effectiveness ratios (CR/PRa) were as follows: adenocarcinoma 13 cases out of 18, 72%; squamous cell carcinoma 12 cases out of 15, 80%. The effectiveness ratios were thus almost the same. Tumor size and primary effect: Out of 19 cases of tumor 5.9 cm or smaller, 17 cases obtained CR. Out of 17 cases of tumor 6 cm or larger, there were 5 cases of CR. Cases of larger-sized tumor thus showed a poorer effect of treatment. Recurrence after radiotherapy: Nine cases of recurrence after radiotherapy were treated by combined use of hyperthermia and radiotherapy. Irradiation of 20 to 40 Gy was combined with 5 to 10 rounds of hyperthermia. The effectiveness ratio was 78%, i.e., 7 cases out of 9. Cases of recurrence of radio-resistant tumor after radiotherapy responded well to low-dose irradiation. Thermo-radiotherapy of deep-seated tumor: Twenty-two cases of deep-seated tumor were treated with the combined use of radiation therapy and hyperthermia. They comprised 10 cases of rectal cancer, 3 cases each of gastric cancer and uterine cancer, 2 cases each of lung cancer and sarcoma, and 2 cases involving other regions. The treatment results were: 3 cases each of CR, 15 cases of PR, and 4 cases of NR. The effectiveness ratio (CR + PRa) was 8 cases out of 22, i.e., 36%. Thermo-chemotherapy: Systemic administration of anti-cancer drug was combined with hyperthermia, and 16 cases were treated. They comprised 11 cases of gastric cancer, 3 cases of colo-rectal cancer, and one case of bile duct cancer. The administered drug was 5-FU in 8 cases, MMC in 7 cases, and CDDP in one case. The treatment results were; one case of CR, 4 cases of PR, 6 cases of MR, 3 cases of NC, and 2 cases of PD. More cases of lymph node tumor showed excellent results.

Early change of adenosine triphosphate levels in L5178Y cells during hyperthermia.

The time course of the change of cellular ATP level was studied in L5178Y cells exposed continuously to various temperatures and compared with that of cell death determined by means of a dye-exclusion test. The ATP level first increased at all temperatures tested and then decreased at temperatures higher than 42 degrees. The onset of this decrease always preceded the beginning of cell death. The results support the idea that the cellular lethality of heat treatment is well correlated with cellular ATP content in L5178Y cells.

[Clinical application of local hyperthermia combined with antineoplastic agents].

At present hyperthermia shows great promise when combined with other modalities. Local thermo-chemotherapy may also be a very attractive research field, but the combination of hyperthermia and anti-cancer drugs is still poorly understood. In this review, the background and the clinical reports on heat and chemotherapy which have been reported during the last year were analyzed. Finally, our clinical experiences with local hyperthermia combined with anti-cancer drugs for gastrointestinal cancer were also reported.

[Low-dose methotrexate and sequential 5-FU treatment in advanced gastric cancer].

Combination chemotherapy of low-dose methotrexate and sequential 5-FU was given to 16 patients with advanced gastric cancer. Treatment regimen : methotrexate 30 mg/m2 followed 3 hours later with 5-FU, 750 mg and 24 hours later with leucovorin 30 mg/m2. Each drug was administered as a bolus. Treatment was repeated weekly. The median ECOG PS was 3 (range 2-4) and median age was 55.1 years (range 28-87). Of these 16 patients who were evaluated, four had PR, and 5 had MR, giving a response rate of 25%. Of the 7 patients who had been previously treated with a combination of chemotherapy including 5-FU, the figures were 2 PR and 3 MR. This regimen has been well tolerated by the patients. No patient had a WBC nadir of less than 2000 cells/mm3, and no patient had a platelet count nadir of less than one hundred thousand platelets/mm3. No other toxicity was detected.