The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer.

OBJECTIVE: To clarify the usefulness of endoscopic ultrasonography (EUS) and endoscopy in the endoscopic mucosal resection (EMR) of early gastric cancer. Patients/Methods-EMR was performed in 61 patients with early gastric cancer over the past five years. The accuracy of the assessment of the depth of cancerous invasion was studied in 49 patients who had EUS before EMR. Forty eight patients were treated with endoscopy alone; in these patients, EUS and endoscopic findings correlated with the clinical course. RESULTS: Forty six patients showed no changes in the submucosal layer or deeper structures on EUS. Pathologically these included 37 patients with mucosal cancer and nine with submucosal cancer showing very slight submucosal infiltration. Three patients showed diffuse low echo changes in the submucosal layer on EUS; pathologically, these included two with submucosal cancer and one with mucosal cancer with a peptic ulcer scar within the tumour focus. Of 48 patients receiving endoscopic treatment alone, 45 showed no tumour recurrence or evidence of metastases on EUS and endoscopy. Three cases of recurrence were observed. Two of these patients had a surgical gastrectomy, and one was re-treated endoscopically. In the former cases, the surgical results correlated well with assessment by EUS and endoscopy. In addition, the latter patient who was re-treated endoscopically after evaluation with EUS and endoscopy has so far had no recurrence. CONCLUSION: The combined use of EUS and endoscopy is effective in diagnosing the depth of cancerous invasion in patients undergoing EMR as well as in clarifying changes both within and between anatomic levels during follow up.

Effect of diltiazem on acute myocardial ischemia. Study of the relationship between regional myocardial blood flow and myocardial energy metabolism.

To examine the effects of diltiazem on myocardial ischemia, 200 micrograms/kg of diltiazem were injected intravenously into anesthetized open-chest mongrel dogs 10 min after coronary ligation. This was followed by a continuous infusion of diltiazem at 10 micrograms/kg/min for 50 min. Regional myocardial blood flow (MBF) was measured by the hydrogen gas clearance method. Sixty minutes after ligation, myocardial specimens were taken from the areas where MBF was measured, and the ATP and CP contents were determined by the bioluminescence method. Simultaneously, mitochondria were isolated from the ischemic and nonischemic areas, and both the respiratory control index (RCI) and the rate of oxygen consumption in state III (QO2 III) were calculated. The aortic systolic pressure and heart rate of diltiazem treated and untreated dogs were not significantly different, and diltiazem did not increase the MBF in the area with a MBF below 40 ml/min/100 g. When MBF was 10 to 30 ml/min/100 g, the ATP content in the diltiazem treated hearts was significantly higher than that in the untreated dogs, whereas the CP content was not significantly changed. Thus, diltiazem administered after ischemia preserved ATP content in the ischemic myocardium with a MBF of 10 to 30 ml/min/100 g without significantly affecting the hemodynamics or MBF. This suggests that diltiazem exerts a cardioprotective effect by acting directly on the ischemic myocardium if it has an MBF above a certain level, even when the drug is administered after the onset of ischemia.

In vitro sensitivity test of stomach cancer tissues by the use of metal grid method.

Ninety-nine specimens obtained from 53 patients with stomach cancer were cultured for about 3 days by means of the stainless steel grid method. In vitro effects of antitumor drugs on the cancer cells were evaluated autoradiographically or biochemically using a liquid scintillation counter to measure the uptake of 3H-thymidine. The radioactivity of the labeled tumor cells of both control fragments and fragments affected by drugs varied greatly among individual tumors. Therefore, the in vitro efficacy of antitumor drugs was represented as a comparison with that of control fragments. Positive correlation between in vitro tests and the clinical effects of antitumor drugs was observed in the specimens of 18 cases.

Protracted oral chemotherapy with fluorinated pyrimidines as an adjuvant to surgical treatment for stomach cancer.

Studies of oral chemotherapy of 5-fluroruracil (5-FU) combined with FT-207, a furanyl analog of 5-FU, as an adjuvant to surgical treatment of stomach cancer have been performed since 1970 in the first department of surgery of Chiba University, Japan. These studies were performed on 107 patients with curative stomach cancer and 22 patients with non-curative stomach cancer. These patients received consecutively 3.5mg/kg/day of 5-FU and 8mg/kg/day of FT-207 for 24 to 36 months and were compared with control patients who had undergone only surgical treatment. A significant higher survival was observed in the curatively resected patients receiving oral 5-FU and FT-207, as compared to the control group. Studies on non-curative stomach cancer patients treated with the same dose schedule gave encouraging results. Because of the limited number of patients treated in this study, the drawing of reliable conclusions must wait the results of further studies.

Value of lymphocyte reactivity induced by phytohemagglutinin in the treatment of malignant diseases.

An improved micromethod for evaluating in vitro lymphocyte blastogenetic activity, a modification of the method of Park and Good, is devised and used in 111 stomach cancer, 34 colorectal cancer, and 22 breast cancer cases. Follow-up information on the lymphocyte blastogenetic activity levels was available in 28 stomach cancer patients after the clinically complete removal of the tumor. In 16 patients with early stomach cancer the lymphocyte blastogenetic level did not differ greatly from a control values from healthy volunteers. However, in 66 advanced stomach cancer cases, statistically lower levels were encountered. After the complete removal of the tumor in 28 stomach cancer patients, the lymphocyte blastogenetic values rose postoperatively. The lymphocyte blastogenetic levels in patients with curative colorectal cancer or curative breast cancer were significantly higher than those patients with non-curative tumors.

Effect of N1-(2'-tetrahydrofuryl)-5-fluorouracil and 5-fluorouracil on nucleic acid and protein biosyntheses in Ehrlich ascites cells.

N1-(2'-Tetrahydrofuryl)-5-fluorouracil (FT-207) is a derivative of 5-fluorouracil (5-FU) and has been accepted as a new chemotherapeutic drug. The inhibitory effects of FT-207 and 5-FU on nucleic acid and protein biosyntheses in Ehrlich ascites cells were compared. Both drugs markedly inhibited the incorporation in vivo of the labeled precursors into nucleic acid and protein. The inhibitory effect of FT-207 on DNA and RNA synthesis lasted for a long period of time. Two hr after administration of 5-FU (250 mug/g body weight), the absolute size of uracil pool of liver increased by at least 50%. However, in an in vitro study, FT-207 at a concentration of 60 mug/ml produced no effect on the incorporation of precursors into DNA and RNA of Ehrlich ascites cells 3 hr incubation. If 5-FU was added to Ehrlich ascites cell suspension simultaneously with [5-3H]uridine, the incorporation of the labeled precursor into RNA increased by 30 to 50%.