Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy.

BACKGROUND: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. METHODS: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. RESULTS: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). CONCLUSION: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

[Significance of radical recurrent tumor resection for recurrent gastric cancer as assessed by prognosis].

To evaluate the relationship between radical surgery of recurrent tumor and prognosis in cases of recurrent gastric cancer, we analyzed data on 202 patients with relapsed gastric cancer, focusing on surgical recurrent tumor removal. In our series, 18 of the 202 patients underwent radical recurrent tumor resection. Resected tumors were located in the ovarium (n = 4), colorectum (n = 3), liver (n = 3), lymph node (n = 2), locoregional stoma (n = 2), and peritoneum, adrenal gland, brain, and lung (n = 1 each). No surgery-related mortality occurred. One patient remains alive over 5 years after hepatectomy without recurrence, and 17 died within 3 years: 7 patients from primary recurrence and 10 from multiple modes of recurrence. Median survival after recurrence (MSTAR) in the 18 radical surgery patients was 14 months, against 5 months in those treated palliatively (p = 0.0001). MSTAR for the ovary and the liver were 30 months and 15 months in the radical surgery cases, and 2.5 months for the ovary and 5 months for the liver in the palliative cases. Significant differences were thus seen between radical and palliative cases in the ovary (p = 0.010) and in the liver (p = 0.036). Median survival after gastrectomy was 45 months in the radical surgery cases, and 28 months in the palliative cases (p = 0.024). In postoperative gastric cancer follow-up, early detection of recurrence and radical surgery may well benefit patients with relapse, especially in the liver and ovary, in terms of survival.

[Significance of laparoscopy for response assessment of chemotherapy in gastric cancer].

UNLABELLED: We performed laparoscopy before and after chemotherapy in two patients with relapsed and advanced gastric cancer, whose major metastatic sites had been diagnosed as being in the peritoneum. A change in tumor responses when assessed by laparoscopy was found. Case 1: A 63-year-old man presented with an umbilical metastasis and suspected peritoneal metastases after gastrectomy. Laparoscopy revealed peritoneal metastases before chemotherapy. After one course of chemotherapy the umbilical tumor disappeared (CR). Laparoscopy after two courses of chemotherapy revealed increasing peritoneal metastases (PD). The overall response was PD. Case 2: A 67-year-old woman was referred to our hospital with a diagnosis of type 4 gastric cancer. Staging laparoscopy revealed massive lymph node metastases and the patient was positive in peritoneal washing cytology. After four courses of chemotherapy, the primary tumor and the metastatic lymph nodes had decreased in size (PR). In contrast, laparoscopy revealed increasing peritoneal metastases (PD). The overall response was PD. CONCLUSION: In patients with peritoneal and other modes of metastasis, tumor response to chemotherapy may be misjudged by conventional imaging alone. Intraperitoneal examination by laparoscopy provides accurate information, including the tumor response to chemotherapy.

An acidic polysaccharide having activity on the reticuloendothelial system from the root of Astragalus mongholicus.

An acidic polysaccharide, designated as AMon-S, was isolated from the roots of Astragalus mongholicus BUNGE. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 7.6 x 10(4). It showed significant reticuloendothelial system-potentiating activity in a carbon clearance test. It is composed of L-arabinose: D-galactose: D-galacturonic acid: D-glucuronic acid in the molar ratio of 18:18:1:1, in addition to small amounts of O-acetyl groups and peptide moiety. A part of the hexuronic acid residues exist as the methyl esters. Methylation analysis, carbon-13 nuclear magnetic resonance and periodate oxidation studies enabled elucidation of its structural features and revealed mainly alpha-arabino-beta-3,6-galactan type structural units.

A novel neutral polysaccharide having activity on the reticuloendothelial system from the root of Glycyrrhiza uralensis.

A neutral polysaccharide, named glycyrrhizan UC, was isolated from the root of Glycyrrhiza uralensis Fischer. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 69,000. Glycyrrhizan UC is composed of L-arabinose:D-galactose:D-glucose:L-rhamnose in the molar ratio of 10:30 27:1. Methylation analysis, carbon-13 nuclear magnetic resonance and periodate oxidation studies indicated its structural feature as an arabino-3,6-galacto-glucan type polysaccharide.

Constituents of the seed of Malva verticillata. VI. Characterization and immunological activities of a novel acidic polysaccharide.

A novel acidic polysaccharide, designated as MVS-VI, was isolated from the seeds of Malva verticillata L. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 26000. It is composed of L-arabinose: D-xylose: D-galactose: D-glucose: L-rhamnose: D-galacturonic acid in the molar ratio of 30: 15: 20: 3: 2: 10, in addition to small amounts of peptide moiety. Methylation analysis, carbon-13 nuclear magnetic resonance and periodate oxidation studies indicated its structural features to have mainly acidic alpha-arabino-3,6-beta-galactan type structural units. MVS-VI showed significant reticuloendothelial system-potentiating activity in a carbon clearance test, and it possesses remarkable anti-complementary activity.

Characterization of two polysaccharides having activity on the reticuloendothelial system from the root of Glycyrrhiza uralensis.

Two polysaccharides, called glycyrrhizans UA and UB, were isolated from the root of Glycyrrhiza uralensis Fischer. They were homogeneous on electrophoresis and gel chromatography, and showed reticuloendothelial system-potentiating activity in a carbon clearance test. Glycyrrhizan UA is composed of L-arabinose: D-galactose: L-rhamnose: D-galacturonic acid in the molar ratio of 20:14:1:3, and glycyrrhizan UB is composed of L-arabinose: D-galactose: D-glucose: L-rhamnose: D-galacturonic acid in the molar ratio of 12:10:1:10:20, in addition to small amounts of O-acetyl groups and peptide moiety, respectively. About 10% (glycyrrhizan UA) and 35% (glycyrrhizan UB) of the D-galacturonic acid residues exist as the methyl esters. Methylation analysis, carbon-13 nuclear magnetic resonance and periodate oxidation studies indicated their structural features.

Anti-complementary and hypoglycemic activities of the glycans from the seeds of Malva verticillata.

Seven polysaccharides and peptidoglycans obtained from the seeds of Malva verticillata were tested for anti-complementary activity. Remarkable activities were observed for MVS-I and MVS-IIA. The former is mainly composed of beta-1,3-linked D-glucan and of alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan, and the latter is essentially alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan. Further, considerable activities were observed for MVS-IIIA and MVS-IVA. Both glycans possess arabino-3,6-galactan moieties accompanying alpha-1,3-linked L-arabinopyranosyl, beta-1,4-linked D-xylosyl, and alpha-1,4-linked D-galacturonic acid units. In addition, the major neutral polysaccharide (MVS-I), the major peptidoglycan (MVS-V), and the polysaccharide-rich fraction (MVS-V-CH) obtained from MVS-V were tested for hypoglycemic activity. MVS-I especially showed remarkable activity, and MVS-V-CH also exhibited significant activity. From the viewpoint of structural features, the latter belongs to pectic substances.

Characterization of polysaccharides having activity on the reticuloendothelial system from the rhizome of Curcuma longa.

Three polysaccharides, named ukonan A, ukonan B and ukonan C, were isolated from the rhizomes of Curcuma longa L. They were homogeneous on electrophoresis and gel chromatography, and showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test. They are composed of L-arabinose: D-xylose: D-galactose: D-glucose: L-rhamnose: D-galacturonic acid in the molar ratios of 12:4:12:1:4:10 (ukonan A), 12:4:12:1:2:4 (ukonan B) and 8:3:6:14:2:3 (ukonan C), in addition to small amounts of peptide moiety. Methylation analysis, carbon-13 nuclear magnetic resonance and periodate oxidation studies indicated the structural features of ukonan B, the major one in terms of the activity. It has acidic arabino-galactan type structural units.

Characterization of an acidic polysaccharide from the seeds of Malva verticillata stimulating the phagocytic activity of cells of the RES.

An acidic polysaccharide, designated as MVS-IVA, was isolated from the seeds of Malva verticillata. It showed a remarkable reticuloendothelial system potentiating activity in the carbon clearance test. Chemical and spectroscopic studies demonstrated that the polysaccharide is rich in alpha-L-arabinofuranose residues and possesses mainly an alpha-1,5-linked L-arabino-beta-3,6-branched-D-galactan structure accompanied with rhamnogalacturonan type units. Both alpha-1,3-linked L-arabinopyranose and beta-1,4-linked D-xylopyranose residues were also identified as component units. MVS-IVA contains a small amount of protein (3.3%).

A reticuloendothelial system-activating arabinoxylan from the bark of Cinnamomum cassia.

A neutral polysaccharide, named cinnaman AX, was isolated from the dried bark of Cinnamomum cassia Blume. It was homogeneous on electrophoresis and gel chromatography. It is composed of L-arabinose: D-xylose in the molar ratio of 4:3, and its molecular weight was estimated to be about 1.0 x 10(6). Methylation analysis, carbon-13 nuclear magnetic resonance and controlled Smith degradation studies enabled elucidation of its structural features. It showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test.

An acidic polysaccharide having activity on the reticuloendothelial system from the roots and rhizomes of Saposhnikovia divaricata.

An acidic polysaccharide, named saposhnikovan C, was isolated from the roots and rhizomes of Saposhnikovia divaricata Schischk. It was homogeneous as judged by electrophoresis and gel chromatography, and showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test. It is composed of D-galacturonic acid:L-rhamnose:L-arabinose:D-galactose in a molar ratio of 27:7:8:8, and its molecular mass was estimated to be 132000. About 30% of the D-galacturonic acid residues exist as the methyl esters. O-Acetyl groups were identified, and the content amounted to 3.3%. Methylation analysis, carbon-13 nuclear magnetic resonance, and controlled Smith degradation studies indicated the structural features. It has a pectin-like rhamnogalacturonan backbone with branched arabinan and galactan side chains.

The major pectic arabinogalactan having activity on the reticuloendothelial system from the roots and rhizomes of Saposhnikovia divaricata.

The major acidic polysaccharide, named saposhnikovan A, was isolated from the roots and rhizomes of Saposhnikovia divaricata. It showed remarkable reticuloendothelial system-potentiating activity in a carbon clearance test. It is composed of L-arabinose: D-galactose: D-galacturonic acid in the molar ratio of 6:15:10, and its molecular weight was estimated to be 54000. About 35% of the D-galacturonic acid residues exist as the methyl esters. Methylation analysis, 13C-nuclear magnetic resonance, and controlled Smith degradation studies indicated that the polysaccharide has the alpha-1----4-linked D-galacturonan backbone bearing alpha-1----5-linked L-arabino-beta-3,6-branched D-galactan side chains.