Stratification-Based Investigation of Adjunctive Brimonidine or Timolol to a Prostaglandin Analogue in Japanese Patients with Normal-Tension Glaucoma.

PURPOSE: We previously investigated the efficacy and safety of adding 0.1% brimonidine (Brim) or 0.5% timolol (Tim) to prostaglandin analogue (PGA) monotherapy to treat patients with normal-tension glaucoma (NTG) with intraocular pressure (IOP) of ≤16 mmHg. Herein, we describe an additional post-hoc stratifying analysis of the possible differences in the effect of IOP-lowering and pulse rate (PR) after adjunctive Brim or Tim to PGA. PATIENTS AND METHODS: This study included 128 subjects. Patients with NTG treated with PGA were stratified based on their baseline IOP. The changes in IOP from baseline and the effect of patient factors on IOP changes were investigated. Patients were stratified by age for investigation of their PR and blood pressure (BP). The change and the effect of patient factors on PR and BP were investigated. RESULTS: After stratification analysis, in 52 eyes treated with Brim and 61 eyes with Tim with baseline IOP 12 ≤ IOP ≤ 16 mmHg, both eye drops lowered IOP significantly (P < 0.0001), and the IOP-lowering efficacy of Brim was non-inferior to that of Tim. However, in 9 Brim- and 6 Tim-treated eyes with baseline IOP of <12 mmHg, no statistically significant decrease in IOP was evident with either eye drop. In the Tim group, PR decreased significantly (P < 0.05) after stratification by age. CONCLUSION: The IOP-lowering efficacy of Brim was non-inferior to that of Tim after stratification by baseline IOP (12 ≤ IOP ≤ 16 mmHg). The discrepancy in the IOP-lowering effects of Brim and Tim observed in the previous study was thought to be related to enrolled subjects with low baseline IOP. PR decreased significantly in the Tim group even after age stratification. PR should be considered when selecting ß-blockers for glaucoma treatment.

An exaggerated blood pressure response to exercise is associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

AIM: This study was designed to examine the associations between an exaggerated systolic blood pressure (SBP) response to exercise and the nutrient intake in normotensive subjects. METHODS: The subjects consisted of 302 normotensive subjects (64 males and 238 females; age, 48.4 ± 11.3 years) without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The nutrient intake was assessed using a self-administered food frequency questionnaire. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP ≥210 mmHg in males, or ≥190 mmHg in females). RESULTS: An exaggerated SBP response to exercise was observed in 85 subjects. A multiple logistic regression analysis revealed that the dietary sodium-to-potassium (Na/K) ratio (odds ratio [OR]: 5.75, 95% confidence interval [CI]: 2.37-13.75, p = 0.001) and vitamin E intake (OR: 0.67, 95% CI: 0.51-0.93, p = 0.012) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP during exercise was found to be significantly associated with an increase in the dietary Na/K ratio (p for trend = 0.0005) and a decrease in the vitamin E intake (p for trend = 0.018). CONCLUSIONS: These results suggest that an exaggerated SBP response to exercise was associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

Effects of Lifestyle Modification on an Exaggerated Blood Pressure Response to Exercise in Normotensive Females.

BACKGROUND: This study was designed to examine the effects of a lifestyle modification on the improvement in an exaggerated systolic blood pressure (SBP) response to exercise in normotensive females. METHODS: The subjects were 78 normotensive females with (n = 25) and without (n = 53) an exaggerated SBP response to exercise who were not taking any medications. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP: ≥190 mm Hg). A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 weeks. The brachial-ankle pulse wave velocity (baPWV), plasma nitrate/nitrite (NOx), plasma thiobarbituric acid-reactive substances (TBARS), high-sensitivity C-reactive protein, fibrinogen levels, and the white blood cell (WBC) counts were measured before and after 12-week intervention. RESULTS: After 12-week intervention, the exercise-induced SBP elevation decreased in an exaggerated SBP response group (P < 0.05). In addition, the plasma NOx significantly increased, and the WBC counts and plasma TBARS decreased in an exaggerated SBP response group (P < 0.05). In an exaggerated SBP response group, a stepwise multiple regression analysis showed that the percent change in exercise-induced SBP elevation was independently associated with the percent changes in the plasma NOx level and baPWV (r2 = 0.647, P < 0.0001). CONCLUSIONS: These results suggest that a lifestyle modification is considered to be important for reducing an exaggerated SBP response to exercise by improving the arterial stiffness and nitric oxide bioavailability.

Influence of a home-based exercise program on the urine pH in elderly female subjects: a secondary analysis of a randomized controlled trial.

BACKGROUND: A low urine pH is a characteristic metabolic feature of metabolic syndrome and type 2 diabetes. The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise on the urine pH status of elderly female subjects. METHODS: The current study is a secondary analysis of a randomized controlled trial (RCT) in which 59 postmenopausal female subjects were randomized to either the exercise group (n = 29) or the control group (n = 30). The subjects in the exercise group were instructed to perform home-based exercises using a bench step at the anaerobic threshold (AT), with a goal of performing ≥140 min/week at home for 12 weeks. The subjects in the control group were instructed to not change their normal lifestyle. Urine was collected after overnight fasting, and the urine pH was measured using a urinary test strip. The inter-group-differences at baseline and the pre-post changes within groups were assessed using the Mann-Whitney U test and Wilcoxon's signed-rank test, respectively. Additionally, the difference in the post-intervention urine pH levels of the two groups, adjusted for the pre-intervention values (the estimated effect size) and the precision (95% confidence intervals) were investigated using an analysis of covariance. RESULTS: The pre-post comparison of the urine pH data using Wilcoxon's signed-rank test showed a significant increase in the urine pH levels of the exercise group (p < 0.05); there was no significant change in the urine pH levels of the control group. However, the estimated effect size (0.15) was small and the confidence interval straddled 0 (-0.25-0.55). CONCLUSIONS: Based on the results of the current secondary analysis of an RCT, we could not clearly conclude that exercise has a beneficial effect on the urine pH. Further well-designed RCTs should be conducted to determine whether aerobic exercise is truly able to ameliorate urine acidification. TRIAL REGISTRATION: The study was retrospectively registered in the University Hospital Medical Information Network (UMIN) as "Effect of step exercise on aerobic fitness and progression of atherosclerosis in the elderly" under the registration number UMIN 000026743 (the date of registration: March 28, 2017).

An exaggerated blood pressure response to exercise is associated with nitric oxide bioavailability and inflammatory markers in normotensive females.

This study was designed to examine the associations of an exaggerated systolic blood pressure (SBP) response to exercise with the indices of nitric oxide (NO) bioavailability, oxidative stress, inflammation and arterial stiffness in normotensive females. The subjects included 84 normotensive females without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The brachial-ankle pulse wave velocity, plasma nitrate/nitrite (NOx), plasma thiobarbituric acid-reactive substances, high-sensitivity C-reactive protein (hs-CRP) and fibrinogen levels and the white blood cell count were measured. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP: ⩾190 mm Hg). An exaggerated SBP response to exercise was observed in 27 subjects. A multiple logistic regression analysis revealed that the hs-CRP (odds ratio (OR): 1.05, 95% confidence interval (CI): 1.03-1.07, P=0.015) and plasma NOx levels (OR: 0.92, 95% CI: 0.87-0.98, P=0.014) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP was found to be significantly associated with an increase in the hs-CRP (P for trend=0.006) and a decrease in the plasma NOx levels (P for trend=0.001). These results suggest that an exaggerated SBP response to exercise was associated with the NO bioavailability and inflammatory status in normotensive females.

[Associations of the work duration, sleep duration and number of holidays with an exaggerated blood pressure response during an exercise stress test among workers].

AIM: It has been reported that an exaggerated systolic blood pressure (ESBP) response during exercise, even if resting blood pressure is normal, is associated with an increased risk of future hypertension and cardiovascular disease (CVD). This study was designed to investigate the relationships of work duration, sleep duration and number of holidays with blood pressure response during an exercise stress test among normotensive workers. SUBJECTS AND METHODS: The subjects were 362 normotensive workers (79 males and 283 females; age, 49.1 years). A multi-stage graded submaximal exercise stress test was performed on each subject using an electric bicycle ergometer. The workload was increased every 3 minutes, and blood pressure was measured at rest and during the last 1 minute of each stage. In this study, an ESBP response during exercise was defined according to the criteria of the Framingham Study (peak systolic blood pressure ≥210 mmHg in males, or ≥190 mmHg in females). Working environments, work duration, sleep duration, number of holidays, and physical activity during commuting and work, and leisure time exercise duration were evaluated using a questionnaire. RESULTS: An ESBP response during exercise was observed in 94 (26.0%) workers. The adjusted odds ratio for the prevalence of an ESBP response during exercise was found to be significantly higher with an increase in work duration, decreases in sleep duration and number of holidays (p<0.05, respectively). Moreover, the highest work duration with lowest sleep duration and number of holidays groups had significantly higher adjusted odds ratio for the prevalence of an ESBP response during exercise than the lowest work duration with highest sleep duration and number of holidays groups (p<0.05, respectively). CONCLUSIONS: Based on our results, we consider that the assessment of blood pressure response during exercise and daily life are necessary to prevent the incidence of future hypertension, CVD and death due to overwork in workers with long-work duration, short sleep duration and small number of holidays.

Effects of home-based bench step exercise on inflammatory cytokines and lipid profiles in elderly Japanese females: A randomized controlled trial.

PURPOSE: The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise program on inflammatory cytokines and lipid profiles in elderly females. METHODS: Sixty-two postmenopausal females (65-85 years of age) were randomized to either the bench step exercise group (n=31) or the control group (n=31). The subjects in the bench step exercise group were instructed to perform bench step exercises at the exercise intensity corresponding to lactate threshold (LT), three times per day 10-20 min each session, for a goal of ≥140 min/week at home for 12 weeks. At baseline and 12 weeks, circulating levels of nine inflammatory cytokines (high-molecular-weight adiponectin, interleukin-4 [IL-4], IL-5, IL-6, IL-8, IL-15, tumor necrosis factor-α [TNF-α], TNF-ß and interferon-γ [IFN-γ]) and serum lipids including high-density lipoprotein cholesterol (HDL-C) were measured. RESULTS: The bench step training at the LT significantly increased HDL-C levels and decreased IFN-γ concentrations in the subjects with lower (< 63 mg/dL) baseline HDL-C levels (p<0.05). The change in IFN-γ inversely correlated with the change in HDL-C in the exercise group (ρ=-0.56, p<0.01), whereas this association was not observed in the control group. Additionally, principal component analysis-derived index of what we called "inflammatory status factor" was inversely associated with the changes in HDL-C in the exercise group. CONCLUSION: The bench step exercise-induced reduction in the IFN-γ levels may partially explain the degree of improvement in the HDL-C levels with the exercise program.

Effects of exercise therapy alone and in combination with a calcium channel blocker or an angiotensin receptor blocker in hypertensive patients.

We compared the effects of exercise alone and in combination with a calcium channel blocker (amlodipine) or an angiotensin receptor blocker (valsartan) in hypertensive patients. Our results indicated that exercise therapy exerted similar effects on systolic blood pressure whether administered alone or in combination with amlodipine or valsartan; however, diastolic blood pressure decreased significantly when exercise therapy was combined with amlodipine. However, when combined with valsartan, exercise therapy additionally improved the lipid profile of hypertensive patients. Thus, this study enabled the identification of the drugs suitable for combination with exercise therapy in the treatment of hypertensive patients.

Effects of bench step exercise on arterial stiffness in post-menopausal women: contribution of IGF-1 bioactivity and nitric oxide production.

OBJECTIVE: To examine the effect of bench step exercise on arterial pulse wave velocity (PWV) and the associated contribution of insulin-like growth factor (IGF)-1 bioactivity and nitric oxide (NO). DESIGN: Twenty-six elderly (post-menopausal) women were randomly allocated to a bench step exercise group or a control group. The participants in the bench step exercise group practiced a 12-week home-based bench step exercise for 10-20min, 3 times daily (i.e., for a total of 140min/week at the intensity level of lactate threshold (LT)). In addition to conventional risk factors of atherosclerosis, PWV, IGF-1/IGF binding protein (IGFBP)-3 molar ratio (an index for IGF-1 bioactivity), and urinary nitrite/nitrate (NO(x)) excretion were measured before and after the intervention. RESULTS: BMI, systolic blood pressure, fasting plasma glucose, low-density lipoprotein cholesterol, LT, and PWV were significantly improved in the bench step exercise group. A significant positive correlation between changes in PWV and IGF-1/IGFBP-3 molar ratio, and a significant negative correlation between changes in IGF-1/IGFBP-3 molar ratio and urinary NO(x) excretion were found in the bench step exercise group. CONCLUSION: The bench step exercise leads to improvements in not only the classical risk factors of atherosclerosis but also the arterial stiffness in elderly women, partly through NO production via IGF-1 bioactivity.

Frequency of soup intake is inversely associated with body mass index, waist circumference, and waist-to-hip ratio, but not with other metabolic risk factors in Japanese men.

Several previous studies have shown that the intake of soup negatively correlates with the body mass index (BMI), serum cholesterol and triacylglycerol levels, and blood pressure, suggesting that soup intake reduces metabolic risk. However, the correlation between soup intake and various metabolic risk factors has not been well-established. Especially, it has not been investigated in Asian countries. The aim of this study was to investigate the association of the frequency of soup intake and metabolic risk factors such as BMI, waist circumference, waist-to-hip ratio, serum cholesterol, serum triacylglycerol, blood glucose, and glycated hemoglobin. A cross-sectional study of 103 Japanese men aged 24 to 75 years was conducted. The intake of soup and other food was investigated by semi-quantitative food frequency questionnaires. The correlation between the frequency of soup intake and metabolic risk factors was analyzed by multiple regression analysis with a linear model. The median value of frequency of soup intake was 7.0 times per week. After adjusting for confounding factors such as age, energy intake, energy from alcohol intake, current smoking, and estimated energy expenditure, the frequency of soup intake was found to have a significant inverse association with BMI (P=0.040), waist circumference (P=0.024), and waist-to-hip ratio (P=0.001). However, no significant associations with other metabolic risk factors were found. Frequency of soup intake is negatively correlated with obesity-related physical parameters in Japanese men.

Frequency of soup intake and amount of dietary fiber intake are inversely associated with plasma leptin concentrations in Japanese adults.

Previous studies have shown that the intake of soup negatively correlates with the body mass index (BMI), suggesting that soup intake reduces the risk of obesity. In this study, to clarify the association of the intake of soup and various nutrients with plasma leptin concentration, a cross-sectional study on 504 Japanese adults aged 20-76 years (103 men and 401 women) was performed. The intake of soup and various nutrients was investigated by food frequency questionnaires. Plasma leptin concentration was measured in fasting blood by radioimmunoassay. The correlation was analyzed by multiple regression analysis. The average frequency of soup intake was 7.6 times/week. The average plasma leptin concentration was 7.76 ng/ml. After adjusting the confounding factors, the frequency of soup intake has a significant inverse association with plasma leptin concentration. Among the macronutrients, only dietary fiber intake negatively correlated with plasma leptin concentration after the adjustment for potential confounding factors. These results suggest that the intakes of soup and dietary fiber were negatively correlated with plasma leptin concentration in Japanese adults.

The Effect of the Dried-Bonito Broth on Blood Pressure, 8-Hydroxydeoxyguanosine (8-OHdG), an Oxidative Stress Marker, and Emotional States in Elderly Subjects.

Dried-bonito broth (DBB, katsuo-bushi dashi) is commonly used in Japanese cuisine, and is also used as a traditional remedy for recovery from fatigue and improvement of blood circulation. To clarify the effect of DBB on blood pressure, oxidative stress and emotional states, a randomized crossover human trial was performed. Twenty-seven elderly Japanese subjects ingested DBB or water for one month. Measurement of blood pressure and urinary 8-hydroxydeoxyguanosine (8-OHdG) and evaluation of emotional states were performed before and after the ingestion periods. The changes in systolic blood pressure (SBP) during DBB ingestion was significantly lower than that during water ingestion (p = 0.037). Urinary 8-OHdG significantly decreased during DBB ingestion (p = 0.0002). Evaluation of emotional states indicated that composure significantly improved during DBB ingestion (p = 0.034). These results suggest that the daily ingestion of DBB lower SBP, reduce urinary 8-OHdG and might improve emotional states in elderly subjects.

[A resected case of postoperative liver metastasis of a gastrointestinal stromal tumor showing complete response after imatinib treatment].

A 71-year-old man visited the hospital complaining of nausea in December 2002. Following a diagnosis of a gastrointestinal stromal tumor (GIST), partial resection of the stomach was performed in January 2003. The tumor was immunohistochemically positive for c-kit and CD34. The tumor size was 6.5 x 5.0 x 4.5 cm with a mitotic index of 25 out of 50 in the high-power field. The pathological diagnosis indicated a high-risk GIST. Treatment with imatinib at a dose of 400 mg/day was started because of liver metastasis of the GIST in January 2004. The liver metastasis was gradually reduced and exhibited cystic change. We considered that there was a complete response without accumulation by FDG-PET in June 2007. An hepatic segmentectomy was performed and imatinib was discontinued in July 2007. Most intratumorale in the specimen underwent hyaline degeneration after pathological examination, but there were viable cells in a portion of the tumor border. Imatinib treatment was resumed because of recurrence in the remnant stomach four months postoperatively owing to imatinib withdrawal. In making a diagnosis at the cell level by FDG-PET, it was difficult to determine the effectiveness of imatinib, and therefore, it is suggested that imatinib treatment must be continued after surgical resection.

[Results of hepatic arterial infusion chemotherapy with 5-FU and leucovorin for unresectable liver metastases from colorectal cancer].

PURPOSE: Hepaticarterial infusional(HAI)5-FU chemotherapy, which involves the use of interventional radiology technique, has matured technically in Japan in the 1990's. The antitumor effect of 5-FU is enhanced by combination with leucovorin. This study was performed to evaluate the efficacy and toxicity of HAI 5-FU and leucovorin chemotherapy for patients with unresectable liver metastases from colorectal cancer. METHODS: Treatment was given to 20 patients with unresectable liver metastases from colorectal cancer. The chemotherapy regimen consisted of weekly HAI of 5-FU(1,000 mg/body)and leucovorin(250 mg/body)over five hours. The survival and response rates to the therapy were assessed according to RECIST. Hematologic and non-hematologic toxicity was assessed according to CTCAE v3.0. RESULTS: Combined HAI 5-FU and leucovorin therapy was carried out an average of 27 times. The response rate for liver tumors was 75%, and the median survival time was 22 months. The applied regimen caused only mild adverse events. There was no evidence of myelosuppression except for platelet decrease(grade 3)in a patient with chronic renal failure. CONCLUSION: This HAI approach using 5-FU and leucovorin was effective and the therapy for unresectable liver metastases from colorectal cancer was tolerated well. Therefore the HAI approach should be reconsidered as an effective therapy against this disease in Japan.

[Serum levels of estradiol, progesterone and prolactin in patients with Yusho].

To evaluate chronic effect of polychlorinated biphenyls (PCB) and polychlorinated dibenzofurans (PCDF) on sex hormones and prolactin, serum levels of estradiol, progesterone and prolactin were studied in 71 female patients with Yusho and 23 controls in 2006. A negative correlation was found between blood PCB concentrations and estradiol levels. There were no significant correlations between blood PCDF concentrations and estradiol levels, progesterone levels or prolactin levels. However, the mean serum estradiol level was significantly lower in 29 patients with high PCDF concentration (higher than 200 pg/g lipid in blood) than in 30 patients with low PCDF concentration (lower than 200 pg/g lipid in blood). We conclude that abnormality of estradiol levels may be associated with blood PCB concentration and blood PCDF concentration in patients with Yusho.

Effect of lifestyle modification program implemented in the community on workers' job satisfaction.

It is important for occupational health to justify the impact of health promotion programs on job satisfaction, which is associated with work-related outcomes. The aim of this study is to estimate the effects of lifestyle modification activity implemented by the community on job satisfaction, and to analyze the factors which contributed to the improvement of workers' job satisfaction. A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 wk in the community. Data on 264 workers were obtained before and after the intervention. The subjects were asked to fill out questionnaires about work-related items, lifestyle, and mental health status. In addition to the ameliorations of GHQ, lifestyle, subjective complaints, and the risk factors of lifestyle-related diseases, an improvement in workers' job satisfaction was shown by the participation in the community-based lifestyle modification program. For analyzing factors which contributed to the improvement in job satisfaction, logistic regression analysis was employed. Refreshment from fatigue by sleep independently contributed to the improvement of job satisfaction even after adjusting for the other variables. The health promotion program implemented in the community may be useful for workers' job satisfaction especially through the dissipation of fatigue by refreshment sleep.

Effect of the physical activities in leisure time and commuting to work on mental health.

Although some evidence suggests that exercise may improve mental health status, information regarding the intensity and duration of exercise is incomplete. The purpose of this study was to elucidate the association between physical activities in both leisure time and commuting to work and mental health. A questionnaire survey was conducted at three municipal offices in Japan. A total of 670 men and women completed the questionnaire. Mental health status was assessed by the 28-item General Health Questionnaire (GHQ). Respondents were asked about weekly hours of leisure-time exercise for four levels of exercise, and the volume of exercise was assessed using a metabolic equivalent task index. Information about commuting to work on foot or by bicycle was also obtained. The mean GHQ scores were calculated according to physical activity levels using analysis of covariance with adjustment of potential confounders including job stress. In men, the GHQ score decreased steadily with increasing levels of leisure-time exercise, and an inverse association was evident even for mild intensity exercise. Moreover, the GHQ score decreased according to increasing duration of time on commuting to work by either walking or cycling in men, but not in women. These relations did not materially change after adjustment for potential confounding factors. In women, there was no significant association between any of the indices of physical activity. In conclusion, leisure-time exercise and walking or cycling during commuting to work may be associated with better mental health in men.

Hindlimb unloading decreases thioredoxin-related antioxidant proteins and increases thioredoxin-binding protein-2 in rat skeletal muscle.

To investigate role(s) of thioredoxin-related antioxidant proteins in disuse muscle atrophy, we examined the levels of thioredoxin-1 (Trx-1), peroxiredoxin-3/SP-22 (Prx-3) and thioredoxin-binding protein-2 (TBP-2) in rat soleus muscle subjected to hindlimb unloading (HU) for 2, 4, 7 or 14 days. The muscle weight loss was initially observed on day 4. The increases in aclorein- and malondialdehyde-modified proteins, and the decreases in the levels of Trx-1, Prx-3 and Mn-SOD were observed in the late phase of muscle atrophy, whereas, the increase in mRNA expression of TBP-2, a negative regulator of thioredoxin, preceded muscle atrophy. These findings suggest that the decrease of those antioxidant proteins, particularly a marked decrease of Trx-1, may be responsible for the enhanced oxidative damage during the late phase of disuse muscle atrophy. Furthermore, the increase in TBP-2 preceding the muscle atrophy may suppress the thioredoxin-mediated redox signaling, which can be an initial trigger leading to disuse muscle atrophy.

Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia.

PURPOSE: Proximal gastrectomy and lymph node dissection are often performed for T1 cancer of the gastric cardia; however, direct esophagogastrostomy is frequently complicated by reflux esophagitis. We describe a simple technique for preventing esophageal reflux and discuss its results. METHODS: This technique is indicated for T1 cancer of the gastric cardia without lymphadenopathy. Partial resection, including the lesion, is performed, preserving the vagus nerve and lower esophageal sphincter (LES). Lymph node dissection is done around the left gastric, celiac, and splenic arteries. The esophagus is then anastomosed to the anterior wall in the center of the remnant stomach. RESULTS: We evaluated the results of this procedure in eight patients. X-ray films showed no esophageal reflux in either the supine or the right decubitus position. None of the patients complained of reflux or other dyscrasic symptoms, and none had any feeling of microgastria. One patient had some localized erosion near the anastomosis. CONCLUSIONS: This simple and safe technique does not result in post-gastrectomy syndrome or microgastria, and the risk of leaving cancer cells is minimal.