Argyrophilic nucleolar organizer regions in colorectal malignancy: application of typing by their density.

Colorectal neoplasms obtained at colonoscopy were examined by argyrophilic nucleolar organizer region (AgNOR) staining to evaluate the usefulness of AgNOR as a discriminant for malignancy. AgNOR dots were divided into two kinds: 'structures' (larger and less-densely stained) corresponding to the nucleolus, and 'units' (smaller and densely stained) presumed to be true AgNOR within the structure. The number of structures per nucleus did not differ between the adenoma and carcinoma groups, whereas the number of units per nucleus showed a significant difference. However there were several cases showing an overlap between the adenoma and carcinoma groups, leading to a difficulty in deciding whether any given case was benign or malignant. Three types of AgNOR patterns were categorized based on the ratio of units to structure. Type I was defined as the unit being indistinguishable from the structure, Type II as each structure having one to five units, and Type III as at least one structure having six or more units, irrespective of total number of units per nucleus. The colorectal lesions in which more than half of the neoplastic cells showed Type III coincided well with carcinomas histologically diagnosed, with the exception of adenomas with severe atypia. Labeling index of proliferating cell nuclear antigen (PCNA LI) differed between the adenoma and carcinoma groups with a considerable extent of overlap, and correlated to some extent with the AgNOR values. These results showed that the AgNOR staining was useful for determining malignancy and its usefulness appeared superior to PCNA LI.

[Granisetron oral phase III clinical trial--study on the inhibitory effect of granisetron for nausea/vomiting induced by chemotherapy for tumors in the hematopoietic organs].

The efficacy and safety of oral granisetron against nausea and vomiting induced by chemotherapy for tumors in the hematopoietic organs were investigated. Depending on the day of anticancer drug administration, single administration or 2 to 6-day repeated administration of granisetron at 2 mg once daily was conducted. The clinical efficacy rate against nausea and vomiting was 91.6% on the first day of administration of anti-cancer drugs and 90% or over on and after the second day of administration. Compared with the status at the previous chemotherapy, a significant decrease in vomiting frequency was observed during the present trial. Adverse events which were suspected to be related to granisetron included 1 case of mild feeling of residual urine and another demonstrating very mild eosinophilia. From the above results, it was confirmed that granisetron was a safe and effective antiemetic against nausea and vomiting induced by anticancer drug administration.

Ranitidine and sucralfate as maintenance therapy for gastric ulcer disease: endoscopic control and assessment of scarring.

The efficacy of ranitidine (150 mg nocte), and sucralfate (1 g tds) as maintenance therapy to prevent gastric ulcer relapse was evaluated in a 12 month trial in 363 patients. The relapse rates were 8.8% at three months, 14.7% at six months, 18.1% at nine months, and 21.0% at 12 months for the ranitidine group and 14.7%, 21.3%, 29.9%, and 30.2% respectively for the sucralfate group. At nine and 12 months the cumulative relapse rates for the ranitidine group were significantly lower than those for the sucralfate group (p less than 0.05). In both groups ulcers recurred mainly from red scars observed at the endoscopic scarring stage. This indicated the necessity of drug treatment up to the white scar stage. The results suggest that ranitidine is effective in preventing gastric ulcer relapse.

Clinical usefulness of ranitidine in giant gastric ulcer.

We define "giant" gastric ulcer as a chronic gastric ulcer, with a diameter greater than or equal to 3 cm. Treatment of inpatients with several conventional antiulcer agents resulted in significantly lower healing rates in giant gastric ulcer than in "large" (greater than 15 and less than 30 mm diameter) or "medium" (greater than 5 and less than or equal to 15 mm diameter) ulcers. In 48 patients with giant gastric ulcers treated with ranitidine, cumulative endoscopic healing rates were: 0% after 2 weeks, 16.7% after 4 weeks, 50.0% after 6 weeks, 77.1% after 8 weeks, 85.4% after 10 weeks, and 87.5% after 12 weeks of treatment. Corresponding healing rates were determined for the control group, which included patients treated with various conventional antiulcer agents. Comparison of these results revealed that from the fourth week of treatment onward, healing rates of the ranitidine group were significantly higher than those of the control group. There was little difference in the cumulative healing rates in the ranitidine group. From these results, ranitidine is considered to be useful in the treatment of giant gastric ulcer.

Observations on benign gastric ulcer simulating gastric carcinoma.

We have re-evaluated over-diagnosed cases which were first diagnosed, pre-operatively, as gastric cancer yet later confirmed as benign lesion (excavated lesion, in particular) in the post-operative histological examination of resected stomachs. We have experienced a total number of 1,358 cases which, being detected through mass survey, were diagnosed as cancer and, consequently, operated upon. On the other hand, 61 benign cases were misdiagnosed as cancer, 28 cases being protruded lesions and 33 cases excavated lesions. Among the misdiagnosed cases of excavated lesions, 27 cases were gastric ulcers or their scars, the remaining 6 cases being gastritis or gastric erosion. In 22 out of 33 cases of misdiagnosis, the wrong diagnosis was made by relying solely upon X-ray and endoscopy. Even after the addition of cytology, there were still 9 cases of misdiagnosis. Since, however, biopsy was introduced, there have been only 2 cases of wrong diagnosis. We may safely say that through these findings the absolute necessity of biopsy for the attainment of an accurate diagnosis of early gastric cancer has been sufficiently attested.

Roentgenological and endoscopic findings of malignant lymphoma.

Roentgenological and endoscopic characteristics of malignant lymphoma of the stomach were studied referring to the gross pathological appearance of the tumors. Based on the results obtained, we classified malignant lymphoma of the stomach into four types, i.e., superficial, ulcer, polypoid and giant fold types.

Minute gastric cancer.

Nineteen cases of minute early gastric cancer were diagnosed under endoscopical examinations. Diagnosis was established by endoscopic biopsy in 18 cases, and exceptional one case of type IIb was incidentally found. Some of the endoscopic characteristic features of superficial depressed minute cancer were mentioned. By these findings, the diagnosis of superficial depressed minute cancer is possibly made in certain extent only by endoscopic observation. Prognosis of minute gastric cancer is excellent. Especially in the minute early cancer, the actual 7-year-survival rate was 100%. Prognosis of minute advanced cancer is also quite good. Minute gastric cancers can be found clinically and are almost completely curable.

Histo-clinical classification and follow-up study of gastric polyp.

Gastric polyp was found in 1,616 cases or 0.23% of 711,455 persons through the gastric mass-survey. They were classified into 3 groups: hyperplastic polyp in 61%, gastric polyposa in 34%, and polyp composed of metaplastic epithelium with marked atypism (ATP) in 5%. Gastritis polyposa was subclassified into 5 groups according to its histo-clinical features. Malignant degeneration was suspected in 5 or 2.1% of 236 hyperplastic polyps operated, while no polyp which had changed into cancer was experienced among 974 polyps followed-up by biopsy during the time course of 6 months to 11 years at the longest. On the other hand, coexistence of gastric cancer was found in 13% of cases with ATP. In polyps composed of metaplastic epithelium, there are two kinds of polyp: metaplastic polyp in hyperplastic proliferation and neoplastic polyp. In the follow-up study of 1,104 polyps, the growth of polyp was seen in only 14, and 12 of which were hyperplastic polyp. No change from gastritis polyposa to hyperplastic polyp was observed. The increase in size in 14 polyps was seen mostly 3 to 4 years after they were found and was always transient. From these results, it is considered that most of gastric polyps clinically detected have already completed their growth.

Endoscopical polypectomy of the gastric polyp with electro-coagulation wire loop.

A forward-viewing fiberscope equipped with two channels was designed for safer and easier gastric polypectomy under endoscopic control using electro-surgical technique. No electrical accident, bleeding, perforation or significant complications were noticed. Mucosal ulcerations at the polypectomy site healed within a month leaving minor scars behind. In 30 cases, U1 II gastric ulcers developed after polypectomy, which healed leaving convergence of mucosal folds behind. Fiberscopic excision of gastric polyps was also useful for establishing a reliable diagnosis of gastric polyp cancer which is sometimes overlooked by routine biopsy procedure. It may be the "perfect biopsy". The patient with gastric polyp who is aware of his own illness and feels uneasy can be released from his anxiety and regain both physical and mental health at the cost of minimal risks of endoscopic polypectomy.

Extraventricular lesions demonstrated by gastric photofluorographic study.

In a mass survey for diseases of the stomach with photofluography, lesions other than those of the stomach were studied in 85,040 subjects. Gastric lesions were detected in 2.17%, while other lesions were found in 1.97%, giving an approximately similar ratio. Duodenal lesions were found most frequently and in 1.47%, followed by intraabdominal calcification in 0.44%. Among duodenal lesions, duodenal ulcer was seen in 0.14%, and duodenal diverticulum in 0.34%. Among diseases with abdominal calcifications, calcification of lymph nodes was found most frequently and in 0.24%, followed by cholelithiasis in 0.085% and urolithiasis in 0.004%. Lower esophageal lesions were found in 0.05%, in which esophageal diverticulum was the most frequent and found in 0.034%.