Metastasis in para-aortic lymph nodes in patients with advanced gastric cancer, treated with extended lymphadenectomy.

BACKGROUND/AIMS: Lymph node dissection is an essential component of curative resection for advanced gastric cancer. To improve the survival of N2 patients, Asian surgeons have been performing D2+para-aortic lymph node dissection. The current study presents the results of lymph node status from multicenter trial of D2 and D2 + para-aortic nodal (No.16) dissection (D4 dissection). METHODOLOGY: Patients enrolled in the study had potentially curable gastric adenocarcinoma in an advanced stage, T2, T3 or T4/N1 or N2. Patients were randomized to undergo either D2 or D4 gastrectomy. RESULTS: Two hundred and seventy patients were registered and 136 and 134 patients were allocated into the D2 or D4 group, respectively. The average nodal yield of No.16 in D4 group was 18.4 +/- 14.1, ranging from 2 to 84. No.16 metastasis was detected in 12 (9.0%) of 134 D4 patients. One, 9 and 2 patients had simultaneous involvement in N1, N2, and N3 (No.8p, 12, 13 or 14). Namely, in 39 patients who were diagnosed as N2 from the lymph node status in N1 and N2 levels, nine (23.0%) patients had No.16 metastasis. The stage migration by D4 was found in 10 (7.5%). Logistic regression analysis revealed that the stations of No.7 and No.8 were the significant predictors of No.16 involvement. CONCLUSIONS: The present study may strongly suggest that prophylactic D4 dissection may be indicated for patients with N2 involvement, and that No.7 and No.8 are the junctional nodes for D4 dissection.

Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons.

BACKGROUND/AIMS: A randomized study was performed to evaluate morbidity and mortality after D2 (level 1 and 2 lymphadenectomy) and D4 (D2 plus lymphadenectomy of para-aortic lymph nodes) dissection for advanced gastric cancer. METHODOLOGY: Two hundred and fifty-six patients with advanced gastric adenocarcinoma were enrolled (128 to each group). Patients were randomly allocated into D2 (N = 128) or D4 (N = 128) group. The first and second tiers of lymph nodes are removed in D2 dissection. In D4 gastrectomy, the paraaortic lymph nodes were additionally removed. RESULTS: There was no indication of significant distribution bias with regard to age, sex, T-grade, and N-grade between the two groups. Operation time of D4 gastrectomy (369 +/- 120 min) was significantly longer than that of D2 gastrectomy (273 +/- 1103 min), and blood loss of the D4 group (872 +/- 683 mL) was significantly greater than that of the D2 group 571 +/- 527 mL (P < 0.001). Five (4%) and two (2%) medical complications developed in the D2 and D4 groups, respectively. Surgical complications developed in 28 (22%) and 48 patients (38%) after D2 and D4 gastrectomy. The most common complications were anastomotic leakage, pancreatic fistula, and abdominal abscess. Pancreatic fistula developed in 6 (19%) of 32 patients after D4 plus pancreatosplenectomy, but the incidence of pancreatic fistula after D2 gastrectomy plus pancreatosplenectomy was low (6%, 1/16). Two patients died within 30 days of operation (0.8%, 2/256), and each patient belonged to the D2 and D4 group. CONCLUSIONS: Although there is a significantly higher surgical complication rate in D4 dissection, D4 dissection can be done safely as D2 dissection when performed by well-trained surgeons.

Antipromoting effects of 5-lipoxygenase inhibitors, 3-nitro-2,4,6- trihydroxybenzamide derivatives, on TPA-promoted transformation in BALB 3T3 cells.

In order to discover the role in the promotion process of 5-lipoxygenase (5-LO), a key enzyme in the arachidonate cascade, the antipromoting effects of the 5-LO inhibiting 3-nitro-2,4,6-trihydroxybenzamide (NTB) derivatives were studied in a two-stage transformation assay system using BALB 3T3 cells. All compounds inhibited TPA-promoted transformation in a dose-dependent manner. Most of them achieved a 70-80% inhibition. Good correlations were observed between the inhibition of TPA-promoted transformation and that of 5-LO. These results indicate that 5-LO plays an important role in the promotion stage of the transformation of BALB 3T3 cells.

Inhibitory effects of 3-nitro-2,4,6-trihydroxybenzamides on Epstein-Barr virus early antigen induction.

Inhibitory effects of a series of 3-nitro-2,4,6-trihydroxybenzamides on Epstein-Barr virus early antigen (EBV-EA) induction were examined using Raji cells. Some of the tested compounds showed highly inhibitory activity, the N-octyl amide derivative being the most active among them. These results suggest the possibility that 3-nitro-2,4,6-trihydroxybenzamides might be listed as novel inhibitors of tumor promotion.

Inhibitory effects of 3-nitrophloroglucinecarboxylic acid derivatives on Epstein-Barr virus early antigen induction.

The inhibitory effects of two series of 3-nitrophloroglucinecarboxylic acid derivatives, 3-nitro-2,4,6-trihydroxythiobenzamides (II) and 3-nitro-phloroglucinecarboxylates (III), on Epstein-Barr virus early antigen (EBV-EA) induction were examined using Raji cells. Some of them strongly inhibited the induction, N-nonyl and O-decyl derivatives being the most potent inhibitors among the thioamides and esters, respectively. These results suggest the possibility that these two 3-nitrophloroglucinecarboxylic acid derivatives may be listed as novel inhibitors of tumor promotion.

Evaluation of the use of 5-mycoloyl-beta-arabinofuranosyl-(1-->2)-5-mycoloyl- alpha-arabinofuranosyl-(1-->1')-glycerol in serodiagnosis of Mycobacterium avium-intracellulare complex infection.

5-Mycoloyl-beta-arabinofuranosyl-(1-->2)-5-mycoloyl-alpha-ar abinofuranosyl-(1-->1')-glycerol, an antigenic glycolipid from the Mycobacterium avium-intracellulare complex (MAC) was examined for its applicability to the serodiagnosis of MAC infection by ELISA. Serum IgM antibody titres against this glycolipid in healthy controls, pulmonary tuberculosis patients and sputum-MAC-culture-negative MAC patients were generally below the cut-off point (ELISA-negative), whereas most of the MAC-culture-positive MAC patient sera were ELISA-positive (93.5%) and their titres were often very high. Thus, high serum IgM titres against this glycolipid may be said to imply that the MAC disease is in an active phase.

Distribution of antibody titres against phenolic glycolipids from Mycobacterium tuberculosis in the sera from tuberculosis patients and healthy controls.

Sera from tuberculosis (TB) patients and healthy controls were tested by ELISA for their antibody titres against the two major phenolic glycolipids (PGLs) of Mycobacterium tuberculosis, PGL-tbO (a 1:3 mixture of PGL-tb1 and its analogue whose phthiocerol moiety is phenolphthiotriol A) and PGL-tbK. Both PGL-tbs were shown to be specific to M. tuberculosis, and the profiles of serum anti-PGL-tbK titres revealed that PGL-tbK, like PGL-tb1, was fairly widely distributed among strains of M. tuberculosis. Even when these two PGL-tbs were used, however, the rate of ELISA-positives was not very high among TB patients, which is probably explained by the nature of the disease. Moreover, a considerable number of sera from healthy controls, especially from younger age groups, had high anti-PGL-tb titres, which implies that environmental exposure to M. tuberculosis is much higher than has been estimated from the actual TB cases. The ELISA system using these species-specific PGL-tb antigens may be useful for the survey of TB infection, since it gives more direct information on TB infection than the PPD skin test.

Role of chronic Pseudomonas aeruginosa infection in airway mucosal permeability.

The role of Pseudomonas aeruginosa infection in airway mucosal permeability was studied in 16 patients with chronic bronchitis by measuring the amounts of radiolabeled albumin in sputum. One group (A) consisted of six patients (two female, four male, 53 +/- 6 years, SEM) with chronic P aeruginosa infection for 5 +/- 0.9 years. Another group (B) consisted of ten patients (five female, five male, 67 +/- 4 years) without P aeruginosa infection for at least two years. No significant differences between groups A and B were found in the volume of sputum (63 +/- 21 ml/day in group A and 45 +/- 8 ml/day in group B, p = 0.44), the obstructive changes (FEV1 of 57 +/- 6 percent in group A and 51 +/- 4 percent in group B), or the duration of disease (19 +/- 4 years in group A and 14 +/- 4 years in group B). Saliva, sputum, and serum samples were collected at intervals of 2 h over an 8-h period, and at 24 h after intravenous administration of 131I-labeled human albumin. For counting, free 131I was removed by dialysis. Radiocounts (cpm) of saliva were significantly smaller than those of sputum or serum. The cpm from each sputum sample was divided by serum cpm at the time of each sampling. Group A showed significantly higher values in the ratio of sputum- to serum-cpm than did group B at all sampling times. Furthermore, the ratios at 2 and 4 h after 131I-albumin injection significantly correlated with sputum volume per day, whereas they did not correlate with any other factors (age, obstructive impairment, and duration of disease). These findings suggest that chronic P aeruginosa infection produces an increase in airway mucosal permeability to albumin.

MPB64 mycobacterial antigen: a new skin-test reagent through patch method for rapid diagnosis of active tuberculosis.

SETTING: A collaborative study between the Japan BCG Laboratory, Tokyo, Japan, and the Infectious Disease Section, Philippine General Hospital, Manila, the Philippines. Tuberculosis patients from four clinics in the vicinity of Manila, Our Lady of Grace Parish, Sto. Niño de Tondo Parish, the Canossa Health and Social Center, and the Health Care Development Center, were examined. OBJECTIVE: To develop a new, simple and rapid diagnostic method for active tuberculosis. Subjects were tested for skin reaction to a special antigen, MPB64, by the patch test method instead of intradermal injection of purified protein derivative (PPD). DESIGN: Fifty-three active tuberculosis patients and 43 healthy PPD-positive controls were tested to determine whether or not the reaction to MPB64 was positive only in active tuberculosis patients. RESULTS: Fifty-two of the 53 active tuberculosis patients showed a positive reaction to MPB64, while none of the 43 PPD-positive controls did. The specificity of MPB64 to active tuberculosis was 100%, and the sensitivity was 98.1%. The efficacy of the test was 98.9%. CONCLUSION: The patch test with MPB64 is a promising method for the diagnosis of active tuberculosis, distinguishing tuberculous patients from those who are infected but have not developed the disease, and also from BCG-vaccinated individuals. This new skin test is a subject for further evaluation and it is important to compare the results with PPD Mantoux.

Direct measurement of mammographic x-ray spectra using a CdZnTe detector.

Our purpose is to directly measure mammographic x-ray spectra with collimators and a low-efficiency CdZnTe detector developed recently and to find out the best fit response function of CdZnTe detector to correct the measured spectra. Photon spectra (target Mo or Rh) produced by a mammographic x-ray unit at 25-32 kV and 240 mAs (= 3 times of 80 mAs) and transmitted through 0.03 mm Mo or 0.025 mm Rh filter and object (0.1 mm Al to 0.8 mm Al phantoms) have been analyzed. Since detected spectra were distorted by the response of CdZnTe detector and did not present the true photon spectra, the correction was applied by the stripping procedure. The response function of detector used in this procedure has been determined by the evaluation of interactions (K-escape, coherent scattering, and Compton scattering processes) and incomplete charge collection calculated using the Monte Carlo method. We have used Kalpha1, Kalpha2, Kbeta1, Kbeta2 radiations of Cd, Zn, and Te, respectively and have used the weight function for the incomplete charge collection and have considered Compton scattering. The Monte Carlo simulations were continued by changing the important factors (mean path length of hole lambda(h), dead layer of the CZT crystal and weight factor Wq) of incomplete charge collection until the best fit response function was found out. Corrected photon spectra were compared with the mammographic x-ray spectral data of Bureau of Radiological Health (BRH) measured using a Ge detector. Attenuation curves of aluminum for 25-32 kV were calculated from the corrected photon spectra and compared with the attenuation curves measured using an ionization chamber. These results obtained using the CdZnTe detector agreed with the mammographic x-ray spectral data of BRH and attenuation curves obtained by the ionization chamber.

Tachykinin antagonist FK224 inhibits neurokinin A-, substance P- and capsaicin-induced human bronchial contraction.

To determine the roles of endogenously released tachykinins (substance P [SP] and neurokinin A [NKA]) in the human bronchial tissues, we studied the effects of tachykinin antagonist FK224 on bronchial smooth muscle contraction induced by SP, NKA and capsaicin in an organ bath. FK224 (10(-6) M and 10(-5) M, respectively) significantly inhibited NKA-induced contraction and 10(-5) M FK224 shifted the dose-response curve to more than one log unit higher concentration. Because SP- and capsaicin-induced contractions were small, we pretreated the tissues with the neutral endopeptidase inhibitor phosphoramidon (10(-5) M), which inhibits degradation of exogenous tachykinins in order to potentiate the contractions. FK224 (10(-5) M) significantly inhibited SP-induced contraction and it shifted the dose-response curves to about one log unit higher concentration. FK224 (10(-5) M) also significantly inhibited capsaicin-induced contraction and it shifted the dose-response curves to more than one log unit higher concentration. In contrast, FK224 (10(-5) M) did not affect on acetylcholine-, histamine-, and leukotriene D4-induced contraction. These results suggest that FK224 is a tachykinin receptor antagonist in the human bronchial smooth muscle, and that capsaicin-induced contraction is due to endogenously released tachykinin-like substances in the human bronchus.

Surgical treatment for pancreatic metastasis from soft-tissue sarcoma: report of two cases.

We present two cases in which a soft-tissue sarcoma metastasized to the pancreas, but both patients survived as a result of repetitive surgical treatment during a 6- to 10-year period. The first case was a 29-year-old man who had a history of removal of mesenchymal chondrosarcoma in the left thigh in 1986 and who underwent distal pancreatectomy and the enucleation of a tumor in the head of the pancreas because of the development of three metastatic lesions in 1989. Afterward, although metastases were found in other organs, they were resected each time (for a total of five times) and the patient has survived over 10 years. The second case was a 40-year-old woman who had a history of the removal of synovial sarcoma in the right thigh and had 6 surgical resections of local or pulmonary recurrent tumors. She underwent pylorus-preserving pancreaticoduodenectomy in 1993 because of the development of a solitary metastatic lesion in the pancreas and survived more than 6 years after the pancreatectomy. Our report suggests, in selected cases, that long-term survival from pancreatic metastasis of soft-tissue sarcoma is expected as a result of curative resection. However, because pancreatic metastasis has a potential to recur in other organs, it is necessary to take aggressive surgical procedures repeatedly for the treatment of recurrences to improve prognosis after pancreatectomy.

Volatile components in stored rice [Oryza sativa (L.)] of varieties with and without lipoxygenase-3 in seeds.

Lipoxygenase (LOX) is thought to play an important role in the formation of desirable or undesirable flavor and aroma in many plant products. In rice seeds, LOX activity is localized in the bran fraction and LOX-3 is the major isozyme component. We used gas chromatography-mass spectrometry to determine whether the degree of staleness in the flavor of stored brown rice was related to the presence of LOX-3. We found that the amount of hexanal, pentanal, and pentanol in normal raw LOX-3 rice markedly increased during storage at 35 degrees C. That in LOX-3-less rice increased slightly but was a third to a fifth that of normal LOX-3 rice. In cooked rice, the amount of these components from glutinous rice exceeded that in nonglutinous rice, and that in normal LOX-3 rice exceeded that in LOX-3-less rice. These results indicate that the stale flavor production in LOX-3-less rice during storage is less than that in normal LOX-3 rice.

Pseudodistance measures for recognition of curved objects.

A method for the description and identification of curved objects is described in this paper. The shape of a curved object is considered as a surface which is an accumulation of horizontal section boundaries. This is described by the coefficients of a Fourier series expansion of the proposed representative function. Each complicated feature of the shape of the object is decomposed into five simple features: elongatedness, horizontal strain, section shape, torsion, and displacement. Differences of objects as patterns are defined as pseudodistances of corresponding features. Some essential properties such as completeness of the pseudodistance family are explained theoretically. Finally, experimental results of identification of wooden block models and a doll are displayed.

Interleukin-10 production during and after upper abdominal surgery.

STUDY OBJECTIVE: To evaluate the influence of major abdominal surgery on the plasma levels of interleukin-10 (IL-10). DESIGN: Prospective study. SETTING: University hospital. PATIENTS: 10 ASA physical status I and II patients undergoing upper abdominal surgery. INTERVENTIONS: All patients received combined general-epidural anesthesia with isoflurane and nitrous oxide, after insertion of an epidural catheter at T8-T9 dosed with 1.5% lidocaine. MEASUREMENTS AND MAIN RESULTS: Plasma interleukin-6 (IL-6), interleukin-8 (IL-8), and IL-10 levels were determined with an enzyme-linked immunosorbent assay at preanesthesia, 0, 2, and 4 hours during surgery, and at the end of surgery, followed by sampling on the morning of postoperative days 1 (POD1) and 3 (POD3). Before anesthesia and at 0 hours of surgery, IL-10 was not detected. In all ten patients, the plasma levels of IL-10 showed significant elevations and achieved their maximal value 4 hours after the skin incision (p < 0.05 vs. baseline). The plasma IL-10 levels returned to preanesthesia levels on POD3. The plasma levels of IL-6 and IL-8 also increased in the perioperative period. The peak cytokine levels correlated (r = 0. 915, p = 0.0001 for IL-6 vs. IL-8; r = 0.82, p = 0.025 for IL-6 vs. IL-10; and r = 0.641, p = 0.06 for IL-8 vs. IL-10). The peak plasma IL-10 levels significantly correlated with the amount of intraoperative blood loss (r = 0.69, p < 0.05). CONCLUSIONS: In patients undergoing major abdominal surgery, plasma IL-10 levels were elevated during and after operation. IL-10 may modulate the inflammatory responses in the perioperative period.

[A case of intracranial tuberculoma followed by MRI].

A 62-year-old woman with pulmonary tuberculosis was admitted to our hospital. She was completely neurologically free at admission and her CSF was normal. Brain MRI with Gd-DTPA enhancement demonstrated two mass lesions with ring-enhancement in the left temporal lobe and the right frontal lobe. The left temporal lesion had a bright central core with hypointense periphery on T2 weighted image. Extended hyperintense area was observed around this lesions, which represented brain edema. On T1 weighted image, the central core was demonstrated hypointense and its periphery was isointense. After starting antituberculous therapy, MRI revealed paradoxical expansion of left temporal lesion and neurological symptoms worsened temporarily, but, eventually the intracranial lesions diminished in size and disappeared, and the symptoms improved. So we diagnosed her as having intracranial tuberculoma. By long-term following up with MRI, we observed that the central core of the left temporal tuberculoma had changed gradually to hypointense on T2 weighted image and hyperintense on T1 weighted image respectively. We thought that the change of the central core on MRI represented organization of caseated necrosis.

[Clinical experience with cefuzonam in bacterial infection of children].

Clinical studies were performed on cefuzonam (L-105, CZON), a new cephem antibiotic, as follows. Cerebrospinal fluid (CSF) and serum concentrations. CSF and serum concentrations of CZON were measured in 1 case of septic arthritis without meningitis. One hour after 50 mg/kg intravenous bolus injection, the CSF and serum concentrations were 0.10 and 18.1 micrograms/ml, respectively, and CSF to serum concentration ratio was 0.55%. Clinical efficacy CZON was administered to 15 patients in doses ranging 54.5 approximately 212.4 mg/kg/day (94.1 mg/kg/day on average) t.i.d. or q.i.d. for 4 approximately 12 days (6.5 days on average). Of those patients, 9 were with pneumonia, one each was with bronchitis, with tonsillitis, with septic arthritis, with septicemia, with purulent meningitis and with urinary tract infection. The overall efficacy rate was 100%, i.e., efficacy was excellent in 12, good in 3. Bacteriological efficacy was excellent, i.e., 8 of 8 strains were eradicated. Side effects were observed in 2 cases, i.e., one case with loose stool and another with eruption. Laboratory abnormalities to the drug were not observed during the treatment. The above results suggested that CZON would be a useful antibiotic for treating pediatric bacterial infections.

[Clinical evaluation of cefotaxime in internal medicine].

Cefotaxime (CTX) was used for 129 cases in respiratory tract and other infections; 57 cases of pneumonia, 20 cases of bronchopneumonia, 20 cases of acute bronchitis, 14 cases of chronic bronchitis, 7 cases of acute exacerbation of bronchiectasia or pulmonary emphysema, 4 cases of suppurative diseases of the lung, 1 case of pyothorax, 1 case of retropharyngeal abscess, 3 cases of pleurisy and 1 case of urinary tract infection. (A case was excepted on clinical evaluation.) CTX was administered by intravenous injection or drip infusion at a daily dose ranging from 0.5 to 8 g, for a term of 2 to 61 days. The total dose patients received ranged from 3 to 226 g. The results obtained were as follows. Clinical effects; excellent in 45 cases, good in 63 cases, fair in 9 cases, poor in 7 cases and unevaluable in 4 cases. The efficacy rate was 87.1% (108/124). Bacteriological effects; eliminated in 30 cases, decreased in 8 cases, unchanged in 2 cases and replaced in 1 case. The elimination rate was 75.6% (31/41). Side effects and abnormal laboratory findings; general itching, fatigue in lower extremities and albuminuria in 1 case each, and anemia in 2 cases. Increased number of eosinophiles and elevated GOT in 1 case each, elevated GOT and GPT in 3 cases and elevated GOT, GPT and A1-P in 2 cases. These symptoms or abnormal laboratory findings disappeared after the discontinuation or termination of CTX therapy. In view of the above, CTX may be considered to be a clinically useful antibiotic against respiratory tract infections.

Nurses' comprehension and recall process of a patient's message with double-bind information.

We examined nurses' comprehension and recall process of patients' passage with double-bind information. We focused on two modes of communication, tone of voice and content of speech. The experiment followed a 2 x 2 x 2 design with respect to listeners (nurse vs student), tone of voice (positive vs negative), and verbal content (positive vs negative). Subjects were 79 nurses who worked at the university hospital and 99 students who were studying at the Faculty of Nursing. Nurses and students were randomly divided into four subgroups; each was presented one of four professionally tape-recorded scripts representing one possible combination of tone of voice and verbal content on the part of a fictitious patient. Listeners then rated the passages on scales and were asked to recall the passages in detail. Listeners recalled and understood passages better when the modes of communication did not conflict. Accuracy in recall reflected comprehension of passages rather than the listener's feelings about the "patient," especially in double-bind situations. Listeners tended to judge the speaker's feelings by tone of voice rather than verbal content.

[Campylobacter pylori and diseases of the stomach].

In spite of extensive clinical studies the pathogenicity of Campylobacter pylori in various diseases of the stomach is still not fully elucidated. In peptic ulcer Campylobacter pylori has not provided a reasonable explanation for the localized and solitary development of ulcer lesion which is one of characteristic features of this clinical entity. Our previous clinical study revealed that relapse occurs mostly at or near the scar of the preceding ulcer lesion and occurs more often in red scar than in white scar in peptic ulcer. Therefore, the scar was chosen to investigate whether there is a correlation between Campylobacter pylori and relapse. Twenty patients with healed gastric ulcer were biopsied in duplicate at 4 different sites, namely at the center of and near the scar of the preceding ulcer lesion, in the body and pyloric antrum. One of the duplicate specimen was stained, and the other cultured. Number of the colony observed on the plate was highest at the scar center followed by near the scar or in the body, and the pyloric antrum showed the lowest. Campylobacter pylori was detected in 46.7% of red scar, and 20% of white scar. Campylobacter pylori may play a pathogenic role in some patients of peptic ulcer, but not in all. Namely Campylobacter pylori is one of factors which may cause in imbalance between offensive and defensive powers at gastric mucosa and may lead to development of ulcer lesion. In case of positive bacteriological test, therefore, as to presence of Campylobacter pylori, the preventive measure for relapse such as bismuth preparation may be considered.