[Clinical experience of intermittent administration of 5-FU and CDDP to patients with advanced and recurrent gastric cancer].

We administered 5-FU and CDDP (FP) intermittently to four patients with advanced and recurrent gastric cancer. A minor response (MR) and partial response (PR) were achieved in two of four patients who had evaluable lesions for this treatment, and few side effects were observed. Only one patient among six showed grade 2 leucocytopenia after 15 administrations of this chemotherapy, when she had attained a partial response in a lung metastasis. The other patients had no side effects such as bone marrow suppression or digestive symptoms. This intermittent FP treatment may be an effective and promising therapy with few side effects even for the patients with serious conditions.

[Staging laparoscopy for a patient with advanced gastric cancer whose serum CA 19-9 level decreased remarkably after 2 courses of F/P therapy].

The prognosis of patients with Stage IVb gastric cancer remains poor, and therapy for these patients is not easy. Recently, neoadjuvant chemotherapy is thought to be one of the better strategies for such patients. In this paper, we report a 48-year-old female patient with advanced gastric cancer whose serum CA 19-9 level decreased remarkably after 2 courses of F/P therapy. We also operated on this patient with staging laparoscopy, a new and more useful technique for the patients such as the present one. The advantages of staging laparoscopy are as follows: 1. The entire intraabdominal space can be observed from a small wound, and the clinical stage of the patient can be diagnosed more correctly. 2. It is easy to obtain cells from small amounts of ascites or tissues of small nodules in the abdominal wall and lymph node involvements. 3. Patients suffer less pain and movement of the body is not as limited after operation. 4. Administering drugs into the intra abdominal space is easy using this technique. Staging laparoscopy might therefore be one of the better surgical strategies for the patients with advanced patients when selecting a suitable therapy.

[Effect of CDDP/5'-DFUR combination chemotherapy for advanced or recurrent gastric cancer].

CDDP/5'-DFUR combination chemotherapy was performed on 17 patients with non-resected and recurrent gastric cancer (clinical stage were IVb in all patients). They were treated with 1,400 mg/m2 of 5'-DFUR on days 1-4 orally following by withdrawal 10 days, every 2 weeks repeatedly and 80 mg/m2 of CDDP (c. i. v., on day 5, every 4 weeks). This chemotherapy was performed for at least 2 courses on all patients. Eight of 17 patients achieved a partial response and the overall response rate was 47.1% (differentiated type 57.1%, undifferentiated type 45.5%). Response rates of each lesion were as follows: primary foci 42.9%, abdominal lymph nodes 57.1%, hepatic metastasis 60.0% and ascites 33.3%, respectively. Improvement of performance status was seen in 12 of 17 patients (70.6%). The overall median survival time was 227 days. The median outpatient period was 113 days. There was no high-grade toxicity over grade 2. Therapeutic toxicity of grade 2 was manifested as renal dysfunction (23.5%), nausea/vomiting (17.6%), leukopenia (5.9%) and anemia (5.9%). We evaluated the therapeutic effect by visual examination after completion of the second course. However, poor effect and high incidence of renal dysfunction were found in patients treated with this therapy over four times. Therefore, the maximum effect seemed to be revealed after completion of the fourth course. From the present study, CDDP/5'-DFUR combination chemotherapy seems to be effective for patients with high-grade advanced gastric cancer and improved their quality of life.

Enhancement of lymphokine-activated killer cell cytotoxicity implicated in the increased expression of surface adhesion molecules on tumor cells treated with anticancer agents.

We investigated mechanisms underlying lymphokine-activated killer (LAK) cell cytotoxicity in terms of intensity of expression of intercellular adhesion molecule-1 (ICAM-1) and lymphocyte-function-associated antigen-3 (LFA-3) on Daudi and KATO-III cells treated with cis-diamminedichloroplatinum (II) (CDDP) and mitomycin-C (MMC). Enhancement (mean, 49.8%) of ICAM-1 or LFA-3 in mRNA and protein expression on treated tumor cells was found by flow cytometry, slot-blot RNA analysis, and reverse transcription-polymerase chain reaction (RT-PCR). Increases in adhesion and cytotoxicity of LAK cells to treated tumor cells were 10.1% and 17.7%, respectively. Results suggested that increased ICAM-1 or LFA-3 expression by low-dose CDDP or MMC binds LAK cells to tumor cells, helping to kill tumor cells. Thus, LAK cell therapy with anticancer agent pretreatment could be useful for treatment of cancer patients.

[A successful 5'-DFUR and CDDP combination therapy for an advanced gastric cancer complicated with multiple liver metastases].

A 71-year-old man with Borrmann type 3 gastric cancer with multiple liver metastases had been treated with 5'-DFUR 1400 mg/m2/day, p.o. day 1-day 4/2w and CDDP 80 mg/m2 i.v. day 5/4w, which was repeated for 4 cycles. After 2 cycle treatment, all metastatic lesions in the liver disappeared on the computed tomography scan, indicating a complete response. The primary gastric lesion was reduced, indicating a partial response. There was no significant side effect during the 4 cycles of this therapy. He is alive 6 months after the therapy with a partial response. This 5'-DFUR and CDDP combination therapy seemed to be effective for advanced gastric cancer.

Clinical effectiveness of lansoprazole in patients with gastric ulcers: evaluation of quality of ulcer healing based on endoscopic ultrasonographic findings.

The effects of lansoprazole (30 mg/day) in 18 patients with gastric ulcers and the quality of ulcer healing were studied using endoscopy (including dye endoscopy) and endoscopic ultrasonography (EUS). The results showed an 8-week endoscopic healing rate of 94.4% and an S2-stage shift rate of 11.1%. In dye endoscopic findings of 11 S1-stage patients, S1b healing with regenerated mucosa close to S2 was seen in 63.6%. In a study of EUS findings, E0 with few relapses and high quality of healing accounted for 44.4%. When E0 rates were compared with the scarring images seen in endoscopic findings, the rates were 100% for S2, 66.7% for S1b, and 33.3% for S1a. These results indicate that a high degree of ulcer healing was achieved with lansoprazole, as good contraction of the ulcer tissue and early maturation of regenerated epithelium were observed.

Ulcerative colitis associated with Takayasu's disease.

A 25-year-old Japanese woman had both ulcerative colitis and Takayasu's disease and was positive for HLA-A24, BW52, and DR2. She was found to have thickening of the wall of the carotid artery on contrast-enhanced computerized tomography of the neck and chest. Prednisolone, beraprost, and sulfapyridine achieved rapid remission of both diseases.