Clinical evaluation of teprenone, a mucosal protective agent, in the treatment of patients with gastric ulcers: a nationwide, multicenter clinical study.

The recurrence rate of gastric ulcers healing to a white scar is low, whereas that of ulcers healing to a red scar is high. Teprenone is a mucosal protective agent that can promote epithelial regeneration by increasing the mucosal hexosamine content. It promotes white scar formation when administered as maintenance therapy for ulcers. A nationwide, multicenter study was performed to determine whether white scar formation was also promoted when teprenone was used during initial therapy. Analysis of the data from 1249 patients showed that teprenone significantly promoted white scar formation. The presence of severe ulcers (large size and active stage), ulcer location at the gastric angulus, and smoking retarded white scar formation irrespective of the use of teprenone.

[An experimental study on mesenteritis and deformities of the intestinal canal; with special reference to the changes with time of deformities (angulation, distortion, coil-like appearance)].

1. The relationship of the mesenteric inflammation with intestinal loop deformities was made clear and changes of these deformities were examined with time, using experimental model rabbits. 2. The above rabbit was laparotomized and was caused to develop mesenteritis by applying acetic acid onto sigmoid mesentery and descending colic mesentery, then the abdomen was closed. Subjects were divided into 2 groups (A and B); A group and B group were re-laparotomized 3-7 and 21 days later, respectively and were observed for mesentery and loop appearance, then were extirpated for sigmoid colon and descending colon with mesenterium attached thereto. Roentgenograms were taken first with attachment of mesentery, secondly there-without. Then, the intestinal canal was opened and the mucosal surface was observed, together with bleeding and blood flow disturbance in the depth of the wall in transmitted light. 3. As a result, the following conclusions were obtained: 1) Macroscopically, mesentery was marked with redness for A group and with thickening and twitch due to cicatricial contraction for B group. 2) A group near to the third day showed remarkable shortening, narrowing and marginal irregularity of the loop, which disappeared with time and were scarcely observed for B group; these deformities were considered to involve mesenteric inflammations and ischemia caused by secondary blood flow disturbance. 3) A group near to the 7th day and B group showed remarkable angulation, distortion and coil-like appearance; these deformities are considered to have been caused by thickening (stiffness) of the mesentery and its attachment and twitch-distortion due to cicatricial contraction. 4) Coil-like appearance disappeared upon cutting off the mesentery from the loop.(ABSTRACT TRUNCATED AT 250 WORDS)

Corrosive gastritis mimicking linitis plastica carcinoma.

A 59-year-old female with depressive tendencies was admitted suffering from hematemesis and abdominal pain, two hours after ingestion of an unknown amount of toilet bowl cleaner (hydrochloric acid, pH 1.0). A barium study 24 days after ingestion revealed rigid narrowing and granulation of the entire stomach. The esophagus and duodenum were normal. The radiographic results were similar to those obtained for linitis plastica carcinoma of the stomach, but biopsy specimens of the stomach revealed no cancer cells. A total gastrectomy was performed about two months after ingestion to relieve the persistent feeling of nausea. Specimens revealed a rigid and thickening lining and a denuded mucosal surface of the stomach. The cut surface of the specimen showed a remarkable fibrous thickening of the submucosal layer. Microscopic examination failed to reveal a normal mucosal layer except in a narrow area of the fornix, and remarkable fibrosis of the submucosal lining was noted. No cancer cells were found. Corrosive gastritis has a linitis plastica appearance with a predilection for the antrum. Radiological examination revealed the very rare manifestation of a rigid narrowing of the whole stomach mimicking linitis plastica type cancer.

[An autopsy case of gastric metastasis simulating linitis plastica carcinoma from primary linitis plastica carcinoma of the rectum].

Cases of a metastatic involvement of the stomach from a colorectal cancer are extremely rare, and once such case, confirmed by autopsy, is reported. The patient, an 86-year-old woman, had a metastatic lesion of the stomach from a rectal cancer. The rectal cancer was a combined linitis plastica type and signet ring cell carcinoma, and the appearance of metastatic lesion of the stomach had simulated the linitis plastica type cancer. A metastatic involvement of the stomach presenting a linitis plastica type cancer from a breast cancer is well documented, but a linitis plastica type from a colorectal cancer has not been reported. This case is the first report concerning a gastric metastasis presenting linitis plastica type lesion from a colorectal cancer.

[Radiological diagnosis of early esophageal carcinoma].

1. Clinically, intramucosal carcinoma guarantees good prognosis. So, to detect them is very important. 2. Intramucosal carcinoma give rise to slight wall stiffness and/or very fine mucosal abnormality on double contrast view. 3. To detect intramucosal carcinoma, we must pay careful attention to the above abnormalities of the esophageal wall.

Intraarterial digital subtraction angiography in the diagnosis and treatment of gastrointestinal disorders.

During a period of 18 months, intraarterial digital subtraction angiography (IADSA) was performed in 360 patients with various gastrointestinal disorders. This technique was useful both in diagnostic and interventional procedures. Due to increased contrast resolution, hepatic tumors and portal vein systems were better visualized than with the use of conventional angiography. Also, a significant reduction in the dosage of contrast medium resulted in markedly reduced patient discomfort. Small pancreatobiliary tumors were better evaluated on conventional angiograms due to the decreased spatial resolution of IADSA.

Minute lesions of esophageal cancer.

Fifty-four cases of minute esophageal cancer (1 cm or less in the greatest dimension) were collected and analyzed. Of these 67% were mucosal cancer and 28% were submucosal cancer. Prognosis was anticipated to be good as there was only one case of lymph node metastasis and three of vascular invasion. A lesion of 1 cm can be regarded as curable regardless of its depth of invasion. The endoscopic approach with use of a dye staining technique is useful for detection of or screening for minute esophageal cancer.

[Clinical studies on preoperative abdominal arterial infusion of anticancer agents].

Operable patients with gastrointestinal cancer were injected once with MMC 0.4 mg/kg, ADM 0.8 mg/kg or KW 2083 1 mg/kg through the abdominal artery 7 to 15 days before operation. Biopsy was made on liver tissues during operation, and changes of serum biochemical test values were observed before and after operation. In 7 cases of MMC 20 mg arterial infusion, 7 cases of ADM 40 mg and 6 cases of KW 2083 50 mg liver biopsy showed fibrosis around the central vein. Eosin bodies, neutrophils or necrotic lesions were observed in some other cases. Serum biochemical test values were transiently affected with anesthesia, but these changes will have no unfavorable influence on the results of operation and following treatment.

[Chemotherapy of unresectable Borrmann type 4 gastric cancer].

We have reported the results of our questionnaires collected from 108 hospitals all over Japan. The mainly used therapies were 5-FU, tegafur, and MMC in singular medications and 5-FU + MMC, MFC and tegafur + MMC in combined medications. The total cases judged as 'effective' in each hospitals were 71. The breakdown is as follows: 1) 'effective for the primary lesion'--47, 33--expansion of affected site proved by radiological and endoscopic views, 6--improvement only by endoscopic findings, 8--shrinkage of palpable tumor size. 2) 'ineffective for the primary lesion'--24, 11--disappearance or decrease in ascites, 13--improvement of sign and symptom. 50% survival period was 2.9 months in ineffective cases and 8.5 months in all effective cases and 10.5 months in effective cases by radiological and endoscopic findings. Draft of the Criteria of Cancer Chemotherapy for Gastric Cancers proposed by Japanese Research Society for Gastric Cancer, which including the evaluation of Borrmann type 4 cancer, was introduced.

Roentgen diagnosis of carcinoma of the postoperative stomach.

Between December 1968 and December 1983, the authors treated 30 patients requiring gastrectomy for carcinoma of the postoperative stomach. The patients were divided into two groups: 13 patients were operated on for primary carcinoma lesions (Group A) and 17 patients for benign lesions (Group B). Respective areas of carcinoma development and length of time from initial operation to the discovery of carcinoma of the postoperative stomach were investigated. A period of less than 10 years elapsed in 11 of the patients (84.6%) in Group A and advanced carcinoma developed in the area of the suture in many patients. In contrast, a period of more than 10 years elapsed in 16 of the patients (94.1%) in Group B. Early carcinoma was found in four out of six patients after 10-20 years, whereas advanced carcinoma was found in six out of 10 patients after more than 20 years. Carcinoma developed in the gastric remnant or the area of anastomosis in many patients. This suggests that carcinoma that is discovered within 10 years after operation might have been missed at the initial operation or might have recurred. We therefore defined carcinoma discovered more than 10 years after operation as primary stump carcinoma. To determine areas of carcinoma development and macroscopic findings, 91 patients with primary stump carcinoma (consisting of 18 of our patients and 73 patients from the Japanese literature) were compared with those with cancer in the upper third of the stomach (unoperated) (181 of our patients). Primary stump carcinoma was often found in the area anastomosed with the Billroth II operation, and primary early cancer in the gastric stump tended to be protuberant rather than excavative.(ABSTRACT TRUNCATED AT 250 WORDS)