Recent arguments in advanced gastric cancer treatment]

In advanced inoperable gastric cancer patients, survival was significantly prolonged for the group receiving antineoplastic treatment against only the best supportive care group by some randomized controlled studies. Greater prolongation of survival is expected from surgery in CR and PR cases because of the change from inoperable to operable. One problem is that the evaluation of response to the primary site is different between Japan and other countries. Outside of Japan, it is considered that barium contrast studies and routine endoscopy are not sufficient for tumor response assessment at the primary site. I think this is not true evaluation of the response to gastric cancer chemotherapy to exclude primary site assessment. We must generalize the Japanese criteria of gastric cancer chemotherapy throughout the world.     

Active immunization against cancer cells: impediments and advances

OBJECTIVE: This study was conducted to investigate the hypothesis that exposure to "job strain" is related to increased ambulatory blood pressure (ABP). METHOD: Participants were 195 men who wore an ABP monitor for 24 hours on two occasions 3 years apart. Job strain status, evaluated at each assessment, was used to identify four groups: those not having job strain at either assessment (N = 138), those having job strain at both times (N = 15), and two crossover groups. Regression analysis was used to examine the cross-sectional associations of ABP with job strain, controlling for other known risk factors. Repeated-measures analysis of variance was used to examine the association of ABP change with the category of job strain change. RESULTS: The cross-sectional analysis of the Time 2 data yielded almost identical, highly significant effects of job strain on ABP as was shown in our previously published Time 1 analysis. Those in high strain jobs at both times had systolic/diastolic ABPs at work and at home that were, on average, 11/7 mm Hg higher than those with no job strain at both times; the crossover groups had intermediate levels of ABP. The longitudinal analysis showed that those with a high strain job at Time 1, but not at Time 2, had a significant decrease in work and home ABP of approximately 5/3 mm Hg. CONCLUSIONS: The previously reported cross-sectional association between job strain and ABP was replicated at follow-up. The group repeatedly exposed to job strain had higher levels of ABP at Time 2 than either crossover group. Furthermore, change in job strain status partially predicted change in ABP. These results provide new evidence supporting the hypothesis that job strain is an occupational risk factor in the etiology of essential hypertension.     

Progress in diagnosis of gastric cancer and improvement of treatment results]

It is known that growth hormone (GH) contributes to glomerulosclerosis and that this probably occurs via insulin-like growth factor-I (IGF-I). However, the manner by which GH and nephrectomy (Nx) alter IGF-binding protein (IGFBP) mRNA in the kidney has not been fully explained. The effects of GH on renal IGF-I and IGFBP-1, 2, 3, 4, and 5 following Nx were examined in spontaneous dwarf rats (SDRs) which have a complete and specific lack of GH among pituitary hormones. In normal Sprague-Dawley rats (SDs), Nx resulted in significant decreases in levels of IGFBP-1 mRNA and IGFBP-5 mRNA to 62.7 +/- 4.9 and 56.5 +/- 5.0% those of sham-operated kidneys, respectively. Nx did not alter the IGF-I mRNA level in SDs. The levels of IGFBP-2, IGFBP-3, and IGFBP-4 mRNAs were likewise unchanged following nephrectomy. In SDRs, Nx significantly decreased the levels of IGFBP-1, IGFBP-4, and IGFBP-5 mRNA, to 57 +/- 2.6, 46 +/- 12, and 64 +/- 8.1% of sham-operated animals. However, Nx did not alter the levels of IGF-I, IGFBP-2, and IGFBP-3 mRNA. GH injections of nephrectomized SDRs fully normalized the decreased IGFBP-4 mRNA levels, whereas levels of IGFBP-1 and IGFBP-5 mRNA were not reversed. The altered expression of IGFBP-4 mRNA following Nx of SDRs compared to that of SDs appears highly significant since it is known that, unlike SDs, glomerulosclerosis does not fully develop in SDRs following renal ablation. The change in the IGFBP-4 mRNA level might be related to the development of glomerulosclerosis in SDs.     

Prevention: tobacco control and cancer nursing

Trends in surgical practice suggest that pathologists will encounter increased numbers of patients with small invasive ductal adenocarcinomas; small, if any, metastatic deposits in axillary lymph nodes (ALNs); and possibly fewer ALN specimens to examine. New prognostic histologic features may be needed in this environment. We studied histologic features of primary breast carcinoma and ALN metastasis from 86 patients who had stage T1 ductal carcinomas with only 1 ALN metastasis that was 0.5 cm or less and correlated these features with the development of distant metastases to evaluate their potential usefulness as prognostic indicators. The median follow-up period was 5.3 years. Distant metastases developed in 12 patients. Features significantly associated with 10-year distant metastases-free survival were lymph node hilar tissue invasion (HTI) and ALN metastasis size (stage N1a vs N1b). Tumor grade 1 vs grades 2 or 3 approached significance. The presence of HTI also was related significantly to a decreased 10-year distant metastases-free survival in the stage N1b group. Our study suggests that HTI, along with other well-known parameters, is a useful prognostic feature. In addition, it supports the opinion that ALN dissection may provide limited additional information for patients with grade 1, stage Tla, invasive ductal carcinomas. Additional studies are needed to confirm our findings.     

Early gastric cancer mimicking advanced gastric cancer

The clinicopathological features of 37 early gastric cancers mimicking advanced gastric cancer were reviewed retrospectively, and were compared with 596 other early gastric cancers and 126 mp gastric cancers, defined as gastric cancer invading the muscularis propria of the stomach. A greater tumour size (P < 0.005), submucosal invasion (P < 0.005), lymph node and lymph vessel invasion (P < 0.005) and vascular invasion (P < 0.025) were found more frequently in early gastric cancers mimicking advanced gastric cancers than in other early gastric cancers. There were no significant differences in the clinicopathological findings between early gastric cancers mimicking advanced gastric cancers and mp gastric cancers. Patients with early gastric cancers mimicking advanced gastric cancers showed a lower survival rate than patients with other early gastric cancers, but a higher survival than those with mp gastric cancers. The macroscopic appearance of an advanced gastric cancer was an indicator of massive submucosal invasion and lymph node metastasis in early gastric cancer. As early gastric cancers mimicking advanced gastric cancers showed similar clinicopathological findings to mp gastric cancers, these cancers should be treated as mp gastric cancers.     

Lifestyle and gastric cancer: a case-control study

In Hokkaido, Japan, in order to investigate the etiological relation between gastric cancer and lifestyle, a case-control study was conducted, employing 242 cases with this cancer and 484 controls matched for sex, age, and place of residence. Eating meals within a short time, eating until full, irregularity in the time for supper, having dentures, and lack of teeth showed high odds ratios. Putting an excess digestive burden on the stomach by insufficient chewing promotes the development of this cancer. Stress, long working time, irregularity in sleeping time, and gray hair in males showed high odds ratios. A stressful life may be promotive for this cancer through depressed immunoresistance. Logistic regression analysis showed that those who ate meals rapidly, had strong stress and had lost many teeth were at high risk. The linear trend of the dose-response relationship between the number of teeth lost and the odds ratio was highly significant. To avoid stress, to chew foods sufficiently, and to maintain the health of the oral cavity can help to prevent gastric cancer.     

Deletion and down-regulation of mts1/p16 gene in human gastric cancer]

An adult male diver developed limb pains and peripheral neurologic signs following a series of dives. He was treated for acute neurologic decompression illness (DCI) and responded well, but subsequently he deteriorated and developed features of a progressive multisystem disease. Investigation confirmed a clinical diagnosis of polyarteritis nodosa complicated by a mononeuritis multiplex. Vasculitis is uncommon and its masquerade as neurologic DCI may be unique. However, this case empha-sizes the importance of careful clinical assessment and illustrates the potentially wide differential diagnosis of DCI.     

Prevention of gastric ulcer recurrence with tetraprenylacetone

We have carried out an experimental investigation of lesions of the intervertebral disc produced by flexion, lateral bending and rotational forces in an attempt to produce disc herniations. Adult Wistar rats were divided into 4 groups: control and posterior, lateral and rotational herniation. There were 10 rats in each group. The tail between the 5th and 8th vertebral segments was used. A Kirschner wire was inserted into each of 2 adjacent vertebrae and the movement produced had an apex which was anterior or lateral depending on the group involved. Variables such as rupture of the annulus, the cellularity of the nucleus pulposus and the site of the lesion in the disc were studied histologically. The height of the disc, the protrusion, the thickness, and the surfaces of the annulus fibrosus and the nucleus pulposus were measured. In every case we found a nuclear displacement which did not become a protrusion. The surface parameters and the cellularity of the nucleus pulposus are most useful indicators and should be included in any study examining the disc after the injection of substances for treatment.     

Prevention of heart failure]

Heart failure is a major problem of public health, associated with poor outcome in the advanced stage, thus justifying its prevention. Primary prevention is based on the prevention and treatment of its principal etiologic factors, hypertension and coronary artery disease. Broad use of echocardiography or dosage of neurohormonal markers improve detection of asymptomatic left ventricular dysfunction. In ischemic heart disease, coronary recanalisation prevents or limits left ventricular remodeling and dysfunction, even if the "open artery" theory has not been entirely proved. Understanding the deleterous role of neurohormonal stimulation results in a large use of ACE-inhibitors, which beneficial effect has been demonstrated also in case of asymptomatic left ventricular dysfunction. Betablockers, already largely used after myocardial infarction, seem to have also a beneficial effect in heart failure: the same is probably also true for angiotensin II-antagonists. Double blocking of both the sympathetic nervous system and the angiotensin-aldosterone system seems to be recommended. More precisely understanding the pathways signaling the processes of ventricular remodeling and dysfunction points to new potential targets for a preventive treatment: endothelin receptors, apoptosis, oxidative stress, cytokines or even angiogenesis.     

Helicobacter pylori and gastric lymphoma]

BACKGROUND: Continent urinary diversion may be necessary in a range of urological abnormalities. In circumstances where the standard techniques are not possible, alternative innovative techniques may be used. METHODS: In a female patient with bladder exstrophy, a continent diversion was recommended. The appendix was not available, the ureters were not suitable and a continent stoma was fashioned from an isolated segment of colon. RESULTS: The stoma proved to be continent, although it was somewhat stenotic. However, clean intermittent catheterization maintained its patency. CONCLUSIONS: A continent catheterizable stoma may be constructed from a segment of colon. The technique may be considered when other well recognized methods are not feasible.     

Prevention of liver cancer

Hepatocellular carcinoma (HCC) is among the most prevalent and deadly cancers worldwide. Elevated incidence of HCC is strongly associated with hepatitis B virus infection and dietary exposure to hepatotoxic contaminants. Vaccination programs against viral hepatitis hold hope for the eventual reduction of HCC incidence, and screening of cirrhotic patients may provide one mechanism for improving prognosis of HCC patients. Additional efforts have focused on preventing or retarding liver cancer development in populations at risk for HCC mortality. This review highlights recent clinical trials aimed at exploring the efficacy and practicality of chemoprevention efforts in these cohorts. Preclinical findings that provide insight into mechanisms of hepatocarcinogenesis and point to potential strategies for intervention also are discussed. Finally, novel molecular mechanisms contributing to the known ability of chemopreventive agents to inhibit liver cancer in experimental models are explored.     

Diet diversity and gastric cancer

PURPOSE: To document a case of acute retinal necrosis syndrome in an immunocompetent patient who was successfully treated with famciclovir after unsuccessful treatment with acyclovir. METHODS: After diagnosing acute retinal necrosis syndrome in the patient's left eye, we treated him with 13 mg/kg/24 hours of intravenous acyclovir in three daily doses for 14 days, followed by 800 mg of acyclovir five times per day orally. New areas of retinitis developed within the posterior pole despite treatment with the maximum dosage of acyclovir; thus, we used a new antiviral agent, famciclovir. RESULTS: When we administered 500 mg of famciclovir orally every 8 hours for 3 months, the retinitis regressed within 1 month, leaving atrophic granular pigmented scars. CONCLUSION: Famciclovir can effectively treat acute retinal necrosis syndrome in immunocompetent patients.     

Chemotherapy of gastric cancer

At present curative resection is the only radical treatment for gastric cancer, although recently developed combination chemotherapy shows increased activity in treating locally advanced and metastatic disease. Among several combination regimens, those based on biochemical modulation, such as sequential methotrexate/5-fluorouracil or low-dose CDDP/5-fluorouracil, are thought to provide increased efficacy with decreasing adverse reactions in unresectable gastric cancer. Therefore, a prospective randomized clinical trial comparing the prognosis of patients receiving adjuvant multi-agent chemotherapy with those treated only surgically should be pursued for estimation of the clinical benefit of these agents.     

Treatment of gastric cancer

We evaluated an enzyme-linked immunosorbent assay (ELISA) for detecting anti-Jo-1 antibodies in patients with polymyositis (PM) or dermatomyositis (DM) by use of the recombinant fusion protein Jo-1. Sera from 64 patients with PM or DM, from 80 patients with other connective tissue diseases, and from 64 healthy subjects matched for age, sex and race, were studied by the ELISA and by the double immunodiffusion (DID) method. Eight patients with myositis (six PM, one DM and one DM with malignancy) with positive anti-Jo-1 by DID also showed positive results by the ELISA method, whereas five patients with positive anti-Jo-1 by this ELISA showed negative results on DID. One of the five had non-specific results. The incidence of positive results for anti-Jo-1 with the ELISA (18.8%) was greater than that for DID (12.5%), but the difference was not statistically significant. All patients with positive results for anti-Jo-1 by DID were also positive by the ELISA. The ELISA system with the recombinant Jo-1 antigen was useful in the detection of anti-Jo-1 antibodies in patients with PM/DM.     

Prevention of cancer and cardiovascular diseases: a common strategy?

Physical conditioning induces numerous cardiovascular adaptations, including vagotonia and increased cardiac volume and mass. These adaptations characterise the 'athletic heart' and account for most of the normal variants in the athlete's electrocardiogram. Common alterations associated with vagotonia include sinus bradycardia, sinus arrhythmia, junctional escape beats, first degree atrioventricular block and second degree (Mobitz type I) atrioventricular block. Common electrocardiographic variants associated with increased cardiac mass and volume include increased voltage, prominent U waves, intraventricular conduction delays, early repolarisation and increased QT intervals. It is sometimes difficult to differentiate the healthy athlete with an athletic heart from the athletic patient with a diseased heart. Thus, further evaluation may be warranted, especially when the athlete also presents with hypertension and/or abnormalities of the cardiovascular physical examination.