Personality and cancer survival: the Miyagi cohort study.

We tested the hypothesis that personality plays a role in cancer outcome in a population-based prospective cohort study in Japan. In July 1990, 41 442 residents of Japan completed a short form of the Eysenck Personality Questionnaire-Revised and a questionnaire on various health habits, and between January 1993 and December 1997, 890 incident cases of cancer were identified among them. These 890 cases were followed up until March 2001, and a total of 356 deaths from all causes was identified among them. Cox proportional-hazards regression was used to estimate the hazard ratio (HR) of death according to four score levels on each of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for potential confounding factors. Multivariable HRs of deaths from all causes for individuals in the highest score level on each personality subscale compared with those at the lowest level were 1.0 for extraversion (95% CI=0.8-1.4; Trend P=0.73), 1.1 for neuroticism (0.8-1.6; Trend P=0.24), 1.2 for psychoticism (0.9-1.6; Trend P=0.29), and 1.0 for lie (0.7-1.5; Trend P=0.90). The data obtained in this population-based prospective cohort study in Japan do not support the hypothesis that personality is associated with cancer survival.

Alcohol consumption and the risk of cancer in Japanese men: the Miyagi cohort study.

The objective of this study was to investigate the association between alcohol consumption and the risk of total cancer, and to estimate the proportion of total cancer attributable to drinking habit in Japanese men. From June through August 1990, a total of 21 201 Japanese men completed a self-administered questionnaire on various health habits, including alcohol consumption. During 153 389 person-years of follow-up through December 1997, we identified a total of 882 cases of cancer. We used Cox proportional hazards regression to estimate the relative risk of total cancer according to categories of alcohol consumption. The risk for total cancer was significantly higher in ex-drinkers than never-drinkers. There was a dose-response relationship between the amount of alcohol consumed and the risk of total cancer among current drinkers: multivariate RRs in reference to never-drinkers (95% confidence intervals (CI)) were 1.1 (0.8-1.3), 1.3 (1.0-1.7), and 1.3 (1.1-1.7) in current drinkers who consumed less than 22.8 g, 22.8-45.5 g, 45.6 g or more alcohol per day, respectively (P for trend <0.001). Estimated 17.9% (95% CI 3.1-30.5) of total cancer risk was attributable to drinking habit. In our findings, approximately 20% of the total cancer cases in Japanese men may be prevented by alcohol control.

Adenocarcinoma at the esophageal gastric junction arising in an 11-year-old girl.

Gastric adenocarcinoma is one of the most common gastrointestinal (GI) malignancies, especially among Japanese adults, but represents only 0.05% of all malignant pediatric GI tumors. We report a case of gastric adenocarcinoma arising at the esophageal gastric junction of an 11-year-old girl. The tumor was polypoid, measuring 3.0 x 3.0 x 1.2 cm and was light gray and partially red in color with a stalk. Light microscopic examination of the lesion demonstrated adenocarcinoma of variable degrees of both architectural and nuclear atypia with invasion into the submucosa. Immunohistochemical findings of cytokeratin subtypes revealed positive immunoreactivity for cytokeratin subtypes 8, 19 and 20 and negative for 5/6/18, 7, 13 and 14, which is consistent with those of gastric adenocarcinoma. The patient was alive and well 12 months postoperatively.

[A case of giant hepatocellular carcinoma successfully treated by arterial administration of SMANCS].

A 68-year-old male was referred to our hospital for the precise examination of a giant hepatic tumor detected in a mass survey. The lesion occupied most of the right hepatic lobe, further advancing to the medial segment of the left lobe. However, hepatic functions were well preserved (ICG K = 0.141). Considering the characteristic images of the lesion with positive anti-HCV and high titer of PIVKA II (0.860 AU/ml), the diagnosis was hepatocellular carcinoma. First arterial administration of SMANCS was performed on May in 1994, followed by 6 successive procedures with an interval of about 2 months (total dosage 36 mg), resulting in remarkable tumor shrinkage and tumor marker normalization. On January in 1995, a metastatic lesion to the right rib was controlled by 2 mg of SMANCS administered to the intercostal artery combined with radiation therapy (60 Gray). Frequent administrations of SMANCS caused no serious complications, and tumor feeders were well preserved. Therefore, arterial administration of SMANCS is thought to be one choice for the therapy of giant HCC with good functional reserve.

Malignant fibrous histiocytoma of the esophagus.

A 78-year-old man presented with an esophageal polyp that was confirmed by immunohistochemistry and electron microscopy to be malignant fibrous histiocytoma. The tumor was comprised of a proliferation of spindle-shaped cells admixed with bizarre giant cells. These tumor cells were immunoreactive for smooth muscle actin, vimentin, alpha-1-anti-chymotrypsin and CD68. Electron microscopic examination revealed the myofibroblastic and histiocytic features of the tumor cells. No elements of epithelial or myogenic differentiation were found in the tumor. Malignant fibrous histiocytoma of the esophagus is extremely rare, with 10 cases being documented so far in the literature. The differential diagnosis of pleomorphic tumors of the esophagus is discussed.

Effect of omeprazole on ascorbate free radical formation.

In order to study the effect of omeprazole on the K/[H+] value of ascorbic acid (K = the ascorbic acid-ascorbic free radical equilibrium constant), changes of the concentration of ascorbate free radical in guinea pig sera were examined after intraperitoneal administration of omeprazole. Furthermore, to see the in vitro effect of omeprazole on ascorbate free radical, changes were examined in ascorbate solutions after addition of omeprazole. It was found that the K/[H+] value in the serum increased significantly after administration of omeprazole and also that the drug amplified the electron spin resonance (ESR) signal intensity of ascorbate free radical in vitro. These results suggested that omeprazole acts like oxygen radicals.

[Salivary epidermal growth factor in patients with peptic ulcer].

Recent animal studies suggest salivary epidermal growth factor (EGF) has a cytoprotective effect in the upper GI tract and is one of the important factors to promote the healing of experimental ulcer. The present study was undertaken to clarify the role of salivary EGF in peptic ulcer patients. Saliva samples were collected from 129 endoscopically normal subjects and 232 peptic ulcer patients. Salivary EGF concentration was measured by RIA. Salivary EGF output in normal subjects was 5.26 +/- 0.26 (ng/5 min) (mean +/- SE). Those in patients with gastric ulcer (GU), duodenal ulcer (DU) and gastroduodenal ulcer (GDU) were 10.74 +/- 0.15, 8.13 +/- 0.83 and 9.79 +/- 0.91. EGF output in GU and GDU patients were higher than that in normal subjects respectively. Tractable GU patients (healed within 3 months with regular regimen) had higher EGF output than intractable GU patients. Among tractable GU patients, those who had healing within 8 weeks had higher output. EGF output in patients with recurrent GU was lower than that in non-recurrent GU patients. In 10 GU patients, EGF output became higher in healing stage than in active stage. Salivary EGF may promote the healing and prevent the recurrence of human gastric ulcer.

Endoscopic treatment for submucosal tumors of the esophagus: studies in 25 patients.

Twenty-five patients with submucosal tumor of the esophagus were treated endoscopically. All patients underwent submucosography. The tumors were classified as intra-luminal or intra-mural types according to growth pattern. Twenty tumors were resected using electrocautery in single sessions. Another 5 lesions (more than 20 mm in diameter) were subjected to absolute ethanol injections in multiple sessions to necrotize the tissue, after the overlying mucosa was stripped off by electrocautery. These procedures were not accompanied with serious complications such as perforation or massive bleeding. Oozing bleeding occurred in 3 patients, which was easily stopped by topical injection of absolute ethanol with an endoscope. Esophageal stenosis did not occur. Local reccurence of a submucosal tumor was found in a patient after 14 months, and was retreated successfully. Although the wall of the esophagus is thinner than that of the stomach, endoscopic treatment for a submucosal tumor of the esophagus can be performed safely. Submucosography and endoscopic ultrasonography reveals the extent of the tumor in relation to the esophageal wall thickness. These examinations are helpful in preventing complications. Endoscopic treatment for submucosal tumors using electrocautery and topical injection of absolute ethanol were effective and safe.

Efficacy of absolute ethanol injection method for stress ulcer bleeding after major surgeries.

Emergency endoscopy, carried out in 342 cases of UGI overt bleeding at the Third Department of Internal Medicine, Tohoku University during the six year period from June 1979, demonstrated the necessity of endoscopic hemostasis in 171 cases (50%) with active bleeding, adhered fresh blood clot or exposed vessel with bloody gastric juice. The absolute ethanol injection method was applied to achieve hemostasis in all cases including 30 cases (18%) of postoperative stress ulcer bleeding after major surgeries. Temporary hemostasis was obtained successfully in all 30 cases and rebleeding did not develop. New bleedings in 2 cases (7%) were stopped by repeated injections of absolute ethanol. No patients died from bleeding nor underwent emergency or elective operation. Five patients (17%) died from complicated underlying diseases. Perforation developed in one case (3%). In this case new bleeding occurred on two occasions, and each time hemostasis was obtained. However, this patient showed early symptoms of perforation immediately before the third hemostasis, and was operated on after local injection of absolute ethanol. The complete hemostasis was achieved in 100% of postoperative stress ulcer cases by the ethanol method.

Biochemical examination on the increased superoxide dismutase-like plasma substance observed in a state of acute gastric mucosal lesions.

When experimental acute gastric mucosal lesions were produced in guinea pig by water-immersion and restraint stress, superoxide dismutase (SOD)-like substance in the plasma increased. On analysis by gel filtration, it was shown that the molecular weight of the increased SOD-like plasma substance was about 130,000, and even after treatment with trypsin, 84% of this substance remained. Since the molecular weight of intracellular SOD is about 40,000, it seems that this substance is similar to extracellular SOD, located on the endothelial cell-surface, as previously reported by Marklund et al. Our results suggest that in the presence of acute gastric mucosal lesions, SOD-like plasma substance is not identical to intracellular SOD, which derived from cell destruction by stress or free radical-induced microvascular damage or by hemolysis. Furthermore, this substance may itself work as a scavenger of free radicals generated under conditions, such as these described in the present experiment.

Endoscopic findings of bleeding esophageal varices and experimental study.

It has been considered that the rupture of esophageal varices occurs with high incidences, and once bleeding occurs it sometimes cause fetal massive bleeding. However, from our experiences with the active application of emergency endoscopy, the incidence of bleeding from varix was unexpectedly low. From these results, we studied the rupture signs of esophageal varices in experiments on dogs and clinical cases. The actual rupture signs of varices were summarized as active bleeding, adhesion of fresh clot, mucosal protrusion in a conical shape and white discoloration of its top area and mucosal slight elevation and attachment of fibrin thrombi. Further studies, however, are required to determine whether there are any varicose bleedings which do not show the above rupture signs.

Diagnosis of the depth of cancer invasion by submucosography.

A new method was developed to diagnose the depth of cancer invasion using submucosography combined with special charcoal suspension containing mitomycin C, and applied to 8 cases of gastric cancer. Correct diagnosis of the depth of the cancer invasion was obtained in 7 of the 8 cases. As some cases of early gastric cancer can be treated endoscopically, it is important to know the condition of the invasion before any treatment is performed.

New trial of endoscopic treatment for gastric submucosal tumors.

Recently conservative treatment of gastric submucosal tumors is increasing in spite of the absence of definite criteria for histological diagnosis. We have developed a new method of endoscopical treatment of gastric submucosal tumors that have submucosographically intraluminal Pattern I or II, or partly intramural Pattern III. For such tumors with a maximum diameter less than 5 cm, Ist step: partial resection is carried out with the use of high-frequency electric currents, IInd step: for the residual tumor tissue, in vivo tissue solidification is undertaken by local injection of absolute ethanol to induce necrotic exfoliation of the tumor tissue and to prevent of hemorrhage.