Purely laparoscopic pylorus-preserving gastrectomy with extraperigastric lymphadenectomy for early gastric cancer: a case and technical report.

For the purpose of prevention of postgastrectomy syndrome and a less invasive and yet curative oncological resection, a purely laparoscopic pylorus-preserving gastrectomy with extraperigastric lymphadenectomy was performed for a patient with early gastric cancer located in the middle third of the stomach. The patient's postoperative course was uneventful. During his postoperative recovery, the patient experienced very little pain and used analgesic medication only one time. This operation appeared to be oncologically adequate. As of the seventh postoperative month, the patient never experienced dumping syndrome or alkaline reflux gastritis. This procedure is technically feasible and an excellent option because of its reduced surgical invasiveness and better postoperative quality of life.

[Studies on the classification of clinical stage and histopathological grade of gastric cancer, the contribution of clinical findings and clinico-pathological changes including immunological responses].

The data from 329 gastric cancer patients (206 males and 123 females) were applied to the following statistical analysis. The stage of gastric cancer progress, which was determined by the general rules for the gastric cancer study in Japan, the counterpart of the TNM classification was predictable by a multi-variative mathematical model based on Hayashi's quantification theory which allowed to use qualitative variables as well as quantitative ones for the calculation using the variables relevant to clinical findings consisted of the grade of surgical operability, the grade of histopathological change, positive or negative liver metastasis, positive or negative histopathologically detectable lymph-node metastasis and so on. The variables relevant to clinical findings predicted accurately the stage by the above-cited model and multi-variative correlation coefficient (R2) was 0.9475, suggesting that 95% of the values predicted by those variables could identical to the observed value of the cancer stage. The variables relevant to clinical findings contributed only 29% (R2 = 0.2902) to the prediction of the histopathological grade. The stage and the histopathological grade also were predictable with the multi-variative regressive equations using the data of the clinico-pathological examinations which were administered on the day before the operation to 239 patients (139 males and 95 females) of gastric cancer and 82 control surgical patients (50 males and 32 females). The clinico-pathological indicators consisted of the SI values of Con A and PHA, leukocytes' count, lymphocytes' count, serum albumin concentration, B- and T-cell numbers. The factors which contributed to the stage, or the histopathological grade of gastric cancer were extracted respectively through principal component analysis using the respective correlation matrices consisted of the variables used for the calculation of the multi-variative regression equations in order to predict the stage or histopathological grade. For the male patients, the aging factor contributed to both of the stage and the histopathological grade. For the female patients, the factor relevant to the complication such as infectious diseases and low-nutrition emaciating the patient contributed to the cancer stage and the factor relevant to T-lymphocyte function contributed to the histopathological grade.

[Colony formation of mouse primitive hemopoietic progenitors with interleukin-6 and phorbol ester, and their signal transduction].

Colony formation of mouse primitive hemopoietic progenitors with interleukin-6 (IL-6) and 12-O-tetradecanoyl-phorbol-13-acetate (TPA), and their signal transduction were studied. Although IL-6 or TPA alone could not form colonies, their combination gave rise to significant number of colonies from Day-2 post 5-FU bone marrow cells. When colony numbers were compared with those supported by IL-3, IL-6+TPA gave rise to 86 + 47% of colonies formed with IL-3. Time course of colony formation with IL-6+TPA run parallel with that of IL-3. These colonies included not only granulocyte/macrophage (GM) colonies, but also granulocyte/erythrocyte/macrophage/megakaryocyte (GEMM) colonies and blast cell colonies. Delayed addition of IL-6 or TPA decreased colony numbers, suggesting that both IL-6 and TPA were needed from the start of cultures for maximal colony formation. When cultures were started with TPA, and IL-6 was added on Day 2 of culture or later, few colonies developed. These data suggested that IL-6 might be essential to the survival of the progenitors in culture. Chronic exposure of progenitors to TPA prior to the culture with IL-6+TPA suppressed colony formation. Addition of calphostin C, a specific protein kinase C (PKC) inhibitor or genistein and herbimycin A, specific tyrosine kinase (TK) inhibitors to the culture also decreased colony numbers formed with IL-6 and TPA. To clarify which effects of IL-6 or TPA on colony formation were blocked by the inhibitors, the inhibitors were added to preincubation of progenitors with IL-6. Both the PKC inhibitor and TK inhibitors blocked the increase of colonies resulted from a pre-incubation with IL-6. Although delayed addition of TPA enhanced IL-6-dependent colony formation, delayed addition of TPA with either the PKC inhibitor or TK inhibitors canceled the increase of colonies. These data suggested that both signals of IL-6 and TPA might be transduced via activation of PKC and TK, but further studies are needed to confirm that.

Establishment of a novel granulocytic sarcoma cell line which can adhere to dermal fibroblasts from a patient with granulocytic sarcoma in dermal tissues and myelofibrosis.

A novel human myeloid cell line, designated HSM-1, has been established from the pleural effusion of a patient with granulocytic sarcoma (GS) who had been followed as having primary myelofibrosis for 10 years. When he was diagnosed as having granulocytic sarcoma in dermal tissues, no evidence of malignant transformation into leukaemia was found in both the peripheral blood and bone marrow. The established cell line was positive for myeloperoxidase, Sudan black B, Naphthol AS-D chloroacetate esterase. Surface marker analysis revealed that HSM-1 expressed CD4, CD13, CD11a, CD11b, Leu8, CD49b, CD49d, CD49e, CD29 and HLA-DR. To clarify why the unusual myeloid tumours developed in non-haematopoietic tissues, we examined the capability of HSM-1 to bind to skin fibroblast layers. The HSM-1 cells were found to bind to both bone marrow stromal layers and skin fibroblast layers. Among the other myeloid cell lines tested, none was found to bind to skin fibroblast layers. These findings suggest that the GS cell line may be derived from a haematopoietic precursor cell which can bind to skin fibroblasts and is localized in non-haematopoietic tissues resulting in the formation of extramedullary myeloid metaplasia. HSM-1 is a useful tool for analysing the characteristics of granulocytic sarcoma and homing receptors for haematopoietic stem cells.

A case of strut fracture of the new Björk-Shiley mitral valve prosthesis.

We treated a 61-year-old Japanese man with a strut fracture of the new Björk-Shiley mitral valve. This fracture occurred about two months after mitral valve replacement. Emergency reoperation was performed as soon as the chest X-ray showed the fracture, despite the presence of cardiopulmonary shock. He died on the 3rd postoperative day. Similar reported cases of literature are reviewed.