In patients with gastric cancer invading the serosa, there is often peritoneal dissemination. In an attempt to control such peritoneal recurrences, OK-432, a compound composed of penicillin G-treated, attenuated Streptococcus pyogens of human origin, was administered intraperitoneally at the time of gastrectomy. The non-specific antitumor activity of the peritoneal macrophages was investigated for its cytostatic activity against the cultured human lung cancer cell line, QG-90. OK-432 given intraperitoneally significantly increased the number of the peritoneal macrophages (p less than 0.05), and also enhanced the cytostatic activity (p less than 0.01). On the basis of these findings, OK-432 IP after gastrectomy was given to 13 of 68 patients with gastric cancer invading the serosa and who underwent curative resection. The five-year survival rate of patients given the drug was 63.5%, while the rate was 52.9% in those not given the drug. OK-432 IP seemed to be effective when lymph node involvement was nil or limited to around the area of the stomach. The peritoneal recurrence rate was, however, not affected by OK-432 IP. Elevation of body temperature and some dehydration were the only observed side effects of OK-432. In attempts to control peritoneal recurrences in patients with gastric cancer invading the serosa, randomized controlled trials on OK-432 IP are now being designed.
Modes of cancer growth and DNA ploidy were studied in 66 patients with mucosal carcinoma of the stomach. The modes of growth were classified into five histologic patterns; elongated tubular (three patients), expansive (18 patients), tubular and solid (14 patients), carcinoma in situ (10 patients) and infiltrative (21 patients). In every patient, all or most lesions with elongated tubular, expansive, and carcinoma in situ growths were located in the pyloric gland area of the stomach, and were less than 4 cm in diameter. Histologically, the adenocarcinomas papillary or well-, or moderately differentiated. Most lesions with an infiltrative growth were located in the intermediate pyloric and fundic glands areas, depressed in gross appearance, and composed of poorly differentiated glandular or signet ring tumor cells. The lesions with a tubular and solid growth were present in the pyloric gland or intermediate area, and were classified as well-, moderately, or poorly differentiated adenocarcinoma. All lesions with an elongated tubular, tubular and solid, and carcinoma in situ growths, and most lesions with an infiltrative growth showed a narrowly restricted DNA distribution (Type I or II), while most lesions with an expansive growth had mostly a widely scattered DNA distribution (Type III), representing a higher malignant potential.
The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed.The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the Fukuoka Medical Rally (FMR) and the disaster relief team (DRT) were also reviewed and analyzed.Departments of neurology, neurosurgery, emergency, and cardiology were opened sequentially, starting in 2003, with an establishment of facilities of an emergency room (ER), intensive care unit (ICU), stroke care unit (SCU), and coronary care unit (CCU). Regarding educational programs, lectures and demonstrations on basic and advanced life support techniques were given to all staff annually starting in 2004, and resident doctors completed rotations in the ER and the ICU for three months. FCH staff consistently obtained excellent results at the FMR. Ambulance crews attended lectures and received training on EM and intra-tracheal intubation. The numbers of patients taken by ambulance to FCH increased from 129 in 2002 to 2,316 in 2011. The DRT was dispatched to respond to disasters that occurred in Japan.As a secondary emergency hospital, FCH has developed a system to accept emergency patients. This project will contribute to the improvement of the EM system in the area.
Data on 100 patients who had undergone resection for poorly differentiated adenocarcinoma of the stomach with serosal invasion were examined to assess the prognostic significance of the DNA distribution pattern in relation to the histologic tumor cell aggregation pattern. DNA distribution patterns were classified into low and high ploidies and tumor cell aggregation patterns were classified into free-cell, small nest, and large nest types. The rates of high ploidy in the free-cell, small nest, and large nest types were 23.1%, 48.0%, and 66.7%, respectively, with a significant increase according to the degree of aggregation. The high ploidy group and large nest type had a higher incidence of lymphogenous and hematogenous metastasis than the low ploidy group and free-cell type, respectively. DNA ploidy had no prognostic value for the free-cell type of tumor, but differences in prognosis and the incidence of metastasis between the DNA ploidies were evident in the nest-forming type. Aneuploid tumors consisting of a poorly differentiated adenocarcinoma were those with nest formation, from the standpoint of histologic structure and metastatic behavior. The DNA analysis of poorly differentiated adenocarcinomas was of prognostic value, especially in the nest-forming type.
The effect of PSK, a protein-bound polysaccharide and an immunomodulator, on lymphocytes was examined in vitro for 36 patients with gastric cancer and 26 with colorectal cancer. Cultured lymphocytes with PSK at 100 micrograms/ml increased the level of DNA synthesis, as determined by the 3H-thymidine uptake, from 0.9 to 3.0 fold, compared to the PSK non-treated cells. The increase was 1.36 +/- 0.46 fold for the gastric cancer cases and 1.37 + 0.45 fold for the colorectal cancer cases, and these levels were significantly the finding of 1.93 + 0.55 fold for a control group consisting of 15 healthy volunteers (P < 0.01). When the 1.3 fold increase of 3H-thymidine uptake was defined as the PSK-reactive group, 52.8% (19/36) of the patients with gastric cancer and 50.0% (13/26) for colorectal cancer were found in the PSK-reactive group. The PSK-reactive group demonstrated no relation to the age and sex of the patients, tissue differentiation type or tumor advancement. Our findings thus show that the in vitro activation of lymphocytes by PSK can help identify the candidates with either gastric or colorectal cancer who are the best suited to undergo immunochemotherapy including treatment with PSK.
Surgical risk of laparoscopic gastrectomy for gastric cancer in high risk patients was evaluated with E-PASS scoring system.This study was based on 63 patients with gastric cancer who underwent laparoscopic gastrectomy; 14 patients belonging to high risk group (ASA≥3) and 49 classified as low risk group (ASA≤2). Fifty six patients who underwent conventional gastrectomy were used for comparison.Intra- and postoperative complications were found in 4 and 3 of 14 high risk patients, respectively. We found a significant correlation between E-PASS score and complications. E-PASS score in high risk group was significantly higher than the value in low risk group. The estimated in-hospital mortality rate was significantly different between the two groups. When conventional gastrectomy group for high risk patients was compared, postoperative morbidity and mortality rates were similar in two surgical procedures; however E-PASS score and the estimated in-hospital mortality rate with conventional gastrectomy were significantly higher than the value with laparoscopic gastrectomy.There were no fatal complications in high risk patients with laparoscopic gastrectomy and E-PASS score was within safety margin. Extension of laparoscopic surgery in high risk patients was feasible when careful procedure was performed by a surgical team.
