Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer.

BACKGROUND: We retrospectively evaluated the predictive factors for lymph node metastasis in poorly differentiated early gastric cancer (poorly differentiated tubular adenocarcinoma, signet-ring cell carcinoma, mucinous adenocarcinoma) in order to examine the possibility of endoscopic resection for poorly differentiated early gastric cancer. METHODS: A total of 573 patients with histologically poorly differentiated type early gastric cancer (269 mucosal and 304 submucosal), who had undergone curative gastrectomy, were enrolled in this study. Risk factors for lymph node metastasis were evaluated by univariate and logistic regression analysis. RESULTS: Lymph node metastasis was observed in 74 patients (12.9%) (6 with mucosal cancer and 68 with submucosal cancer). By univariate analysis risk factors for lymph node metastasis were lymphovascular invasion (LVI) (presence), depth of invasion (submucosa), and tumor diameter (> 20 mm), ulcer or ulcer scar (presence), and histological type (mucinous adenocarcinoma). By multivariate analysis, risk factors for lymph node metastasis were LVI, depth of invasion, and tumor diameter. In mucosal cancers, the incidence of lymph node metastasis was 0% irrespective of LVI in tumors smaller than 20 mm, and 1.7% in tumors 20 mm or larger without LVI. In submucosal cancers, the incidence of lymph node metastasis was 2.4% in tumors smaller than 20 mm without LVI. CONCLUSIONS: A histologically poorly differentiated type mucosal gastric cancer measuring less than 20 mm and without LVI may be a candidate for endoscopic resection. This result should be confirmed in a larger study with many patients.

Psychiatric and neuropsychological problems in epilepsy surgery: analysis of 100 cases that underwent surgery.

PURPOSE: For the past 20 years (1978-1997), a series of 100 cases of uncontrolled epilepsy had surgery in our department under the stated standard for surgical indications and were followed up for 2-22 years after surgery. METHODS: We evaluated 70 cases of temporal lobectomy, 20 cases of neocortical focal resection, and 10 cases of corpus callosotomy. RESULTS: Analysis of postoperative seizure control showed that 78 cases were class 1 or 2 (no or rare seizures), 14 cases were class 3 (worthwhile improvement), and eight cases were class 4 (no improvement). As generally accepted, temporal lobectomy was the most effective operative procedure, yielding excellent or good results in 87% of the 70 cases so treated. Among the nine cases in whom various psychiatric symptoms developed after surgery, four cases showed neurotic and five cases psychotic symptoms. Patients with psychosis had delusions of various types as a core symptom, combined with other symptoms such as anxiety, irritability, aggression, and depressive state. In two patients with psychosis who had episodes of delusions in the interictal phase before surgery, the symptoms were extremely resistant. The full IQ score of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was increased after temporal lobectomy in 75% of the cases (p < 0.01; n = 44). The general MQ score in 31 cases, however, showed a 50:50 split between increase and decrease postoperatively. In correlation with the dominance of language by the Wada test, the general MQ score in the 15 cases of nondominant temporal lobe resection showed a significant increase (p < 0.05); whereas the MQ in the 16 cases of dominant-side operation did not change. CONCLUSIONS: Our new test, in which hippocampal stimulation and supraspan learning are combined, seems to be efficient for estimating the postoperative outcome of memory function.

[Presacral malignant peripheral nerve sheath tumor in a patient with von Recklinghausen disease: case report].

A 32-year-old woman was admitted to our institution with dysuria and pain in the left foot. She was diagnosed with von Recklinghausen disease based on the physical findings, and an elastic, firm mass was palpable with the fingertip on the posterior wall of the rectum. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a solid tumor, which measured 8 cm in diameter, in the presacral space. The tumor was diagnosed as a presacral solid tumor and the tumor was extirpated. The specimen was a 10 x 8 x 8 cm yellowish solid tumor weighing 250 g. The histopathologic diagnosis was malignant peripheral nerve sheath tumor (MPNST). Presacral MPNST is rarely diagnosed in the early stage, and the prognosis for MPNST patients with von Recklinghausen disease is relatively poor. Tumor resection with wide surgical margins is necessary and close follow-up after surgery is mandatory.

Blood leucocyte subsets of the rat: expression of adhesion molecules and localization within high endothelial venules.

Although several distinct adhesion pathways are now well characterized, it is not clear whether analysis of adhesion molecule expression on leucocytes is sufficient to predict their interaction with endothelium in vivo. Therefore, in the present study this question was addressed by investigating the interaction between blood leucocyte subsets and high endothelial venules (HEV). The expression of different types of adhesion molecule (CD44, alpha 4-integrins, LFA-1, ICAM-1, CD2 and L-selectin) on lymphocytes, NK cells, monocytes and granulocytes of rat blood was determined by flow cytometry. In the same animals the numbers of blood leucocyte subsets present in the HEV of axillary lymph nodes and Peyer's patches were analysed using immunohistology. In the HEV of both axillary lymph nodes and of Peyer's patches lymphocytes (greater than 10,000 per mm2), as well as small numbers of NK cells and monocytes (less than 500 per mm2), were found. In contrast, granulocytes were not detected here. Lymphocytes, NK cells, monocytes and granulocytes each expressed CD44, alpha 4-integrins, LFA-1, ICAM-1, CD2 and L-selectin in a pattern characteristic to cell type, but this did not correlate with the different ability of the leucocyte subsets to interact with the two types of HEV. In conclusion, determining the expression of CD44, alpha 4-integrins, LFA-1, ICAM-1, CD2 and L-selectin on blood leucocytes alone is not sufficient to predict leucocyte/endothelium interaction in vivo.

B and T lymphocyte subsets enter peripheral lymph nodes and Peyer's patches without preference in vivo: no correlation occurs between their localization in different types of high endothelial venules and the expression of CD44, VLA-4, LFA-1, ICAM-1, CD2 or L-selectin.

Many lymphocytes enter tissues such as peripheral lymph nodes, and Peyer's patches through high endothelial venules (HEV). It is known that HEV differ in the expression of adhesion molecules as lymphocyte subsets do. Through the interaction of these molecules B and T lymphocyte subsets are thought to be preferentially directed into lymphoid organs. However, it is unclear which role these mechanisms play in vivo, since there are no studies demonstrating that blood lymphocyte subsets preferentially interact with different types of HEV in vivo. Therefore, in the present study the frequency of B, T, CD4+ and CD8+ lymphocytes in the wall of the HEV of rat peripheral lymph nodes and Peyer's patches was analyzed by immunohistology. In addition, the expression of CD44, VLA-4, LFA-1, ICAM-1, CD2 and L-selectin on B and T lymphocyte subsets of the blood was determined by flow cytometry. Although B and T lymphocytes showed significantly different levels of expression for each adhesion molecule investigated, the relation of B and T lymphocytes within the HEV of peripheral lymph nodes and Peyer's patches was strikingly comparable (38.0 +/- 5.2% vs. 40.6 +/- 5.7% and 62.0 +/- 5.2% vs. 59.4 +/- 5.7%, respectively). The same was true for CD4+ and CD8+ cells. Thus, although HEV and the blood lymphocyte subsets differ markedly in their expression pattern of adhesion molecules, the existing levels are sufficient to mediate comparable entrance of B and T lymphocyte subsets into both types of HEV.