Adenocarcinoma of the stomach: radiological and pathological correlation of effects of treatment with fast neutrons

During the past six years 40 patients have been treated with fast neutrons for inoperable adenocarcinoma of the stomach. A number of these patients have been studied in detail both radiologically and pathologically with regard to the effects of fast neutrons on both the tumour and normal stomach. After treatment there was a constant reduction in size of the stomach capacity when compared with a control group and the motility of the stomach was lost. Mucosal changes, which were noted radiologically, appeared to be dose related. Histologically most of the tumour was destroyed. Small clumps of cells were, however, found in all except one of the patients but only in areas of the stomach which had not received the standard dose. Marked fibrosis occurred and it is our impression that the amount of fibrosis is in excess of that seen with other forms of radiotherapy.     

Identification and immunolocalization of ecto-ATPDase in chicken stomach

The distribution of the extracellular adenosine tri- and di-phosphatase (ecto-ATPDase) in adult chicken tissues was investigated using a monoclonal antibody (MC18) generated previously from chicken oviduct. Ecto-ATPDase was determined to be most abundant in stomach by Western blot analysis of crude tissue homogenates. The ecto-ATPDase activity from solubilized stomach microsomes and a purified oviduct control was depleted 64% and 72%, respectively, by immunoprecipitation with MC18. Both oviduct and stomach ecto-ATPDases had an M(r) of approximately 80 kDa based on SDS-PAGE analysis. In addition, the enzymology of the ecto-ATPDase from both tissues was very similar. It is concluded that the same ecto-ATPDase is present in stomach and oviduct. Furthermore, immunolocalization of the stomach ecto-ATPDase with MC18 showed the enzyme to be localized in the apical membranes of the oxyntico-peptic cells, suggesting a role for the ecto-ATPDase in secretion.     

Sociodemographic differences in the prevalence of self-reported stomach pain in school children

The study considered the prevalence of experienced stomach pain in a nationwide random sample of 2161 Icelandic 11-12 and 15-16-year-old school children. It found an 18.4% prevalence of "at least weekly" stomach pain and a 53.4% overall prevalence. The prevalence of stomach pain was significantly higher among younger children (P < or = 0.001). Higher prevalence (P < or = 0.001) of stomach pain was seen in girls in the overall sample and the gender difference was significant in both age groups. No overall class or residential differences were detected. However, the findings suggest some age-related links between social status and the experience of stomach pain. The frequency of stomach pain was moderately and significantly associated with medication use. The theoretical and clinical implications of the results are briefly discussed. CONCLUSION: The high prevalence of frequent stomach pain found in this study calls for future research documenting further the epidemiology of stomach pain and various bio-psycho-social factors related to the experience and extent of this pain in school children.     

Immunohistochemical detection of K-sam protein in stomach cancer

The K-sam gene, originally isolated as an amplified gene from the stomach cancer cell line KATO-III, is characterized by its preferential amplification in the undifferentiated type (diffuse type) of stomach cancer and encodes one of the receptors for heparin-binding growth factors or fibroblast growth factors. The K-sam gene has been isolated by different methods and has been designated BEK, TK14, and Cek2. The receptor for keratinocyte growth factor was also found to be encoded by the same gene. To examine the expression of the K-sam protein in stomach cancer, polyclonal antibody pK1-2 was raised against the extracellular domain of the gene product. This antibody detected K-sam proteins by Western blot and flow cytometry analyses in stomach cancer cell lines KATO-III and HSC39, in which the K-sam gene is amplified and overexpressed. By immunohistochemical analysis, 20 of 38 cases of the undifferentiated type of advanced stomach cancer were K-sam positive, whereas none of 11 cases of the differentiated or intestinal type revealed K-sam staining. The K-sam product was observed predominantly in diffusely infiltrative lesions. In one autopsy case, the K-sam protein was detected only focally in the primary tumor, whereas markedly increased staining for the K-sam product was detected diffusely in the metastasized tumor in the lymph node and liver. These results suggest that K-sam overexpression is associated with the malignant phenotype of the undifferentiated type of stomach cancer, such as infiltrative growth and metastasis.     

A case of esophageal cancer required jejunal reconstruction because of a gastric ulcer scar

Recently, with increase of number of esophagectomy for esophageal cancer, the cases having the lesion in the organs for esophageal substitute have been increasing. The case of esophageal cancer, required reconstruction using the pedicled jejunum, because of impaired submucosal blood perfusion of the stomach caused by a ulcer scar, was reported. The patient was a 72-year-old female, with the ulcerative and infiltrative cancer lesion in the anterior wall of the mid-thoracic esophagus. Barium swallow revealed shortening of the lesser curvature and indentation of the greater curvature of the stomach. Endoscopy showed the lesion occupying anterior two thirds of the esophageal wall circumferentialy from 30 to 34 cm from the incisor tooth. The lineal scar of ulcer on the lesser curvature of the body of the stomach was also found. Following esophagectomy through right thoracotomy, the stomach was mobilized for reconstruction by dividing left gastric artery and short gastric artery, but the stomach oral to the ulcer scar became ischemic and bleeding was not found at the tip of the stomach. Therefore, reconstruction was performed using the pedicled jejunum through antesternal route. The gastric cardia is rich in the vascular network in the submucosal layer. The ulcer or ulcer scar of this region can cause ischemia in the tip of the gastric tube for esophageal substitute. Care should be taken to detect the ulcer lesion at the stomach preoperatively. In the case with the ulcer lesion blood supply to the tip of the gastric tube should be critically evaluated.     

NMR spectroscopy of human post mortem cerebrospinal fluid: distinction of Alzheimer''s disease from control using pattern recognition and statistics

Mutations of ras oncogenes in 37 human stomach cancers and 13 adenomas were investigated with regard to the histological phenotypes using polymerase chain reaction (PCR), allele-specific oligonucleotide hybridization and/or direct sequencing of the PCR products. The ras mutation was found only in one case (2.7%), the histology of which was poorly differentiated adenocarcinoma. We found no mutation in stomach adenomas. The mutation consisted of a guanine-to-adenine transition in the first base of codon 13 of c-Ki-ras which replaced wild-type glycine with serine, indicating that a putative glycine-to-aspartic acid change is not necessarily the critical event for c-Ki-ras gene activation in codon 13. These results further confirm the infrequency of ras mutation in stomach tumors and also suggest that ras mutations are not specific to the differentiated type of stomach cancer.     

Qualitative research: exploring new frontiers

International Agency for Research on Cancer recognized as sufficient the evidence of Helicobacter pylori (HP) infection carcinogenicity and placed it into the 1st group of carcinogens. The results of the studies performed during last years are discussed. They showed the involvement of HP in the development of stomach cancer. HP enhances mitogenesis of epithelium with translocation of immature cells on the surface of stomach mucous membrane and thus forms the targets for mutagenic and carcinogenic influences. HP takes part in the formation of mutagens, primarily of free oxygen radicals. Achlorohydria is the outcome of HP-gastritis and results in the bacterial growth in the stomach which participate in the formation of N-nitrosocompounds-well known carcinogens. Antitumor stomach defense is weakened by the decrease in the stomach of ascorbic acid, carotin and tocopherol resulting from HP-infection.     

Cholesterol biosynthesis in stomach and intestinal tissue of rat

Biosynthesis of cholesterol and its precursors (metastenol, latosterol and 7-dehydrocholesterol) was studied in the mucous and serous membranes of small intestine, secretory and esophageal regions of the normal rat stomach. The content of these sterols was also determined. The intensity of sodium 2-14C-acetate incorporation into cholesterol and its precursors in the mucous membrane of the small intestine and stomach secretory region is considerably higher than into the same sterols of the serous membrane and esophageal region. Cholesterol synthesis is most intensive in the small intestine mucous membrane and stomach secretory region.     

Kinds of therapy for persons with psychiatric disorders and their families

The paper presents a 17-year-old girl with a big trichobezoar in the stomach, diagnostic and treatment proceeding. In our opinion upper GI tract endoscopy is the most useful adjunct to the diagnosis of all types of stomach besoars.     

Lymph node metastasis in gastric cancer in the upper third of the stomach--surgical treatment on the basis of the anatomical distribution of positive node

BACKGROUND/AIMS: Little is known about the most appropriate surgical procedure for gastric cancer in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for gastric cancer in the upper third of the stomach. METHODOLOGY: The clinicopathological characteristics of 115 node-positive gastric cancers in the upper third of the stomach were reviewed retrospectively and compared with those of 111 node-negative gastric cancers in the upper third of the stomach. RESULTS: Node-positive gastric cancers showed higher rates of peritoneal metastasis (p < 0.005), larger tumor sizes (p < 0.005), deeper tumor penetration (p < 0.005), higher rates of diffuse type in histology (p < 0.025), and more advanced histological stages (p < 0.005), than node-negative gastric cancers. Patients with node-positive gastric cancer demonstrated a poorer survival rate than those with node-negative gastric cancer (p < 0.005). Lymph node metastasis along the lower stomach was observed in cases of gastric cancer which had invaded beyond the muscularis propria of the stomach but not in those confined within the muscularis propria. No lymph node metastasis in the splenic hilum was found in association with gastric cancer when the depth was limited to the mucosa or the submucosa. CONCLUSION: The appropriate surgical procedures for the treatment of gastric cancer in the upper third of the stomach are as follows: a) proximal gastrectomy without splenectomy for gastric cancer when the depth is limited to the mucosa or the submucosa, b) proximal gastrectomy with splenectomy for gastric cancer when the depth of invasion extends to the muscularis propria, c) total gastrectomy with splenectomy for gastric cancer when the depth of invasion extends beyond the muscularis propria.     

Technetium pertechnetate scintigraphy in an ileal duplication of the stomach and duodenum

We report a patient with ileal duplication of the stomach and duodenum that presented with gastrointestinal bleeding. The scan appearance of the duplicated stomach in both shape and temporal course of activity bore a striking resemblance to the patient's homotopic stomach.     

Topographic rapid pH-metry. Possibilities and prospects of use in the functional diagnosis of stomach diseases

More than 700 patients were examined by rapid intragastric pH-metry with the use of original pH-microtubes and K -2 device. Numerous advantages of the method were observed: the tube is easy to introduce into the stomach, the procedure is short, there are no contraindications against it, it involves no complications, pH values can be recorded along the entire stomach (30 cm) with just 1 cm intervals (topographic pH-metry). Diagnostic potentialities of the method are limited because there are no standard pH values for each specific site of the stomach under conditions of basal and stimulated secretion. To specify the standard values. 30 normal subjects and 40 patients with various gastric diseases were examined. Prevailing pH values at all sites of the stomach in health and disease both in basal and pentagastrin-stimulated secretion were established. To make the results more objective, the authors distinguish such parameters as the intermediate and maximal acidity zones, and carry out variation statistical analysis of pH-grams with plotting the variation statistical curves. Reliable differences in all the examined parameters in normal subjects and patients with initial gastric hypo- and hyperacidity were detected. Pentagastrin test is recommended for all patients with initial hypoacidity during express pH-metry. The proposed methods of statistical processing of express pH-grams and the established standard values appreciably extend the diagnostic potentialities of rapid pH-metry of the stomach.     

A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction

We describe a technique to bypass a malignant biliary obstruction by creating a direct connection between the left biliary tree and the stomach. First, adherence between the left liver parenchyma and the stomach is achieved by a Cope anchor system. Then, the left biliary tree and stomach are connected by Colapinto needle puncture of the stomach from a left biliary duct with the needle inserted through a 9 Fr transhepatic sheath. Over a stiff guidewire, a Ring drainage catheter is placed. Later, the Ring catheter is replaced by a metallic stent. Four patients with malignant biliary obstruction underwent this procedure. The mean survival time was 77 days with maximum follow-up of 171 days. Neither obstruction nor dislocation of the metallic stents occurred.     

Morphologic and morphogenetic features of stomach ulcer

Literature data are reviewed concerning morphological and morphogenetic features of stomach ulcer, vascular alterations in both the ulcer zone and other regions of the stomach. Stages in ulcer formation, its healing and prognostic criteria are described. Further study of ulcerogenesis regarding histotopographic features of different regions of gastro-intestinal tract is recommended.     

Myoelectric activity of the rabbit stomach and duodenum following neurogenic and humoral effects

Electrical activity of the duodenum increased after the immobilisation or haemorrhage stress to a greater extent than the stomach and pylorus myoelectrical activity. Pentagastrin or serotonine increased the electrical activity of the duodenum and decreased the stomach and pylorus myoelectrical activity. Chronophysiological mechanism of the gastro-duodenal discoordination is analysed.     

Endoscopic sonography of the stomach: findings in benign and malignant lesions

Endoscopic sonography combines direct visualization of the luminal surface of the gut with sonographic examination of the gut wall and surrounding structures. Lesions arising from different layers of the wall can be identified, staged, and in some cases characterized. Endoscopic sonography is complementary to endoscopy, barium studies, transabdominal sonography, and CT examination of gastrointestinal lesions. A thorough examination with endoscopic sonography may determine the layer of origin, size, echogenicity, and extent of gastric lesions and allows differentiation of lesions arising in the stomach from lesions arising outside the stomach. The purpose of this essay is to illustrate the findings from endoscopic sonography of a variety of benign and malignant lesions of the stomach.     

Antenatal detection of hiatus hernia

A routine ultrasound scan in a primigravida at 29 weeks' gestation showed that her fetus had a fluid-filled viscus above the diaphragm in the mid-line. This was initially thought to be the stomach, either as part of a congenital Bochdalek diaphragmatic hernia or an hiatus hernia. Subsequent scans suggested that this was the stomach with an additional loop of bowel. After birth, laparotomy confirmed that the stomach had herniated into the chest through a very lax oesophageal hiatus. The stomach was easily reduced into the abdomen with no evidence to suggest a congenital short oesophagus, the crura were tightened, and an anterior fundoplication performed.     

Double contrast technique in the proximal stomach

The double contrast technique is of particular value in the proximal stomach, where one is able to detect ulcers and masses not recognized on a conventional upper gastrointestinal series. Pseudotumors which may occur in the fundus with the conventional barium technique are readily resolved. When a lesion in the proximal stomach is suspected by conventional radiography, immediate use of double contrast radiography may confirm or better delineate the lesion. Double contrast examination of the proximal stomach may thus be used as a primary or immediate secondary procedure to increase radiologic accuracy.     

Arterial blood supply of the stomach in esophago-gastroplasty with cervical anastomosis

The supply area of each particular stomach artery was illustrated by the Technovit corrosion technique and X-rays. Despite the extensive skeletonization of the stomach, an adequate blood supply was maintained as a whole, especially the extreme fundus area, solely via the A. gastroepiploica dextra. Our research results provide an important basis for total stomach transposition, after the method of Kirschner, as an esophagus replacement.     

Socioeconomic correlates of infant mortality in Hong Kong, 1979-93

Contractions change the configuration of the lesser curvature of the stomach while they indent the greater curvature. We studied these lesser curvature changes by measuring the position and angle of the gastric incisura on still frames captured from videotapes of isolated cat stomachs suspended in physiologic solution. In response to filling with 100 mL Krebs' solution stomachs generated a tonic contraction of the fundus/body segment and gave rise to a peristaltic contraction that spread from the body and through the antrum to the pylorus. In preparations where we left the duodenal cannula open we found that the incisura moves toward the gastro-oesophageal (GO) junction and the angle of the incisura widens as the contraction passes through the stomach and empties its contents. Furthermore, the angle of the incisura is most acute when the full stomach starts contracting in its fundic segment and again when the contraction involves the gastric sinus (the wedge-shaped segment adjacent to the incisura which forms the transition between the body and the antrum of the stomach). In preparations where the duodenal cannula was kept closed, the angle of the incisura becomes most acute when the contraction involves the gastric body and when the luminal pressure peaks. We conclude that changes in the position and angulation of the incisura are part of the mechanical response of the stomach to filling and emptying; unlike the peristaltic contraction along the greater curvature the net movement of the incisura goes in the orad direction. Movements of the incisura profoundly affect the configuration of the stomach and hence the distribution of luminal contents between various gastric segments. The gastric sling muscles are responsible for the formation of the gastric incisura but their role in any movements of the incisura remains to be defined.