Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach.

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux.

Laparoscopic excision of subdiaphragmatic bronchogenic cyst occurring in the retroperitoneum: report of a case.

Although bronchogenic cysts (BCs) are benign congenital malformations usually occur in thoracic cavity, retroperitoneal location is extremely uncommon. We reported a case of BC occurred in the retroperitoneum, which was excised laparoscopically. A 64-year-old Japanese woman was admitted to the hospital because of submucosal tumor in the upper part of the stomach. An upper gastrointestinal endoscopy revealed a submucosal tumor located just distal to the esophagogastric junction. The abdominal computed tomography scan revealed a cystic mass located in contact with lesser curvature of the stomach and the dorsal surface of the liver. As the cystic mass was well-circumscribed and showed no positive findings suggestive of malignancy, the laparoscopic excision of the cystic mass was performed. The cystic tumor was completely excised with a laparoscopic procedure. The histologic findings indicated that the cyst was surfaced by the ciliated pseudostratified epithelium without the presence of the cartilage, which was compatible with the BC of the retroperitoneum. This case highlights the safety and the feasibility of complete laparoscopic excision of retroperitoneal BC. Laparoscopic excision of retroperitoneal BC definitely provides all advantages of minimally invasive procedure, which improves postoperative patient discomfort and pain and shortens hospital stay. Laparoscopic procedure may definitely be a standard approach for the excision of retroperitoneal BC.

[Clinical characteristics of cases showing complete regression of the primary tumor after S-1 combined with cisplatin administered as neoadjuvant chemotherapy in advanced gastric carcinoma].

Although neoadjuvant chemotherapy has been recognized as an important option to improve the clinical outcome of patients with advanced gastric carcinoma, the precise histological effects of neoadjuvant chemotherapy on the primary and metastatic foci have not well been documented. The aim of the present study was thus to evaluate histological effects of S-1-based neoadjuvant chemotherapy on the resected specimens of gastric carcinoma and regional lymph nodes, and primarily to focus on the histology of the cases showing complete regression of the primary cancer cells. A total of 164 patients received neoadjuvant chemotherapy with the combination of S-1 (80 to 120 mg/body/day for 3 weeks) and cisplatin (35 to 60 mg/m2 on day 8). One course of the regimen was completed in 5 weeks and the next course was started after 2 weeks. A total of 9 patients who showed complete regression of the primary gastric cancer were subjects of the study. A total of 77 cases (46.9%) responded to the neoadjuvant chemotherapy and 9 cases (5.5%) showed a complete regression of the primary gastric carcinoma. Three out of 9 cases had remnant cancer cells in the metastatic foci; 1 in the liver and 2 in the regional lymph nodes. Five of 9 cases were solid-type poorly-differentiated adenocarcinoma (por1), and the incidence of responders was the highest in patients with por1. A total of 8 cases were alive and the mean postoperative survival was 612±192 days. One patient died 518 days after gastrectomy associated with hepatic resection. S-1-based neoadjuvant chemotherapy has significant histological effects on gastric carcinoma and metastatic foci, which may further improve long-term clinical outcome in patients with advanced gastric carcinoma.

Laparoscopic excision of the cystic lymphangioma occurred in the lesser omentum: report of a case and review of literature.

Intraperitoneal cyst occurring in the lesser omentum is extremely rare entity. Because of the absence of abdominal symptoms, omental cyst is occasionally found accidentally in imaging examination performed during health screening. We experienced a case of cystic lymphangioma that occurred in the lesser omentum, which was successfully resected under complete laparoscopic procedure. A 50-year-old Japanese woman was admitted to our hospital because a cystic mass was found in the abdomen. Abdominal computed tomography scan was performed because she had a traffic accident, despite complaining no abdominal symptoms. The abdominal computed tomography scan and magnetic resonance imaging revealed a large cystic mass in the lesser omentum adjacent to the lesser curvature of the stomach, which was resected with a complete laparoscopic procedure. As the cystic wall was closely attached to the lesser curvature of the gastric wall, an ultrasonic coagulating shear was quite helpful to entirely mobilize the cyst from the surrounding structure such as lesser curvature of the stomach. After placing clips to the feeding vessels to the cyst branched from the accessory hepatic vessels, the entire cyst was mobilized without leakage of cystic content. The postoperative course was uneventful with slight delayed gastric emptying due to partial denervation of the lesser curvature of the stomach. The patient was discharged on eighth day after surgery without any postoperative complications. This is the first case of cyst of lesser omentum resected under complete laparoscopic procedure and certainly highlights advantage and feasibility of laparoscopic approach for cases with abdominal cystic lesions. Laparoscopic excision of cystic lymphangioma in the lesser omentum provides all the advantage of minimally invasive procedure.

Delayed vascular injury and severe respiratory distress as a rare complication of a central venous catheter and total parenteral nutrition.

Complications related to central venous catheters (CVCs) in the postoperative period can be fatal. We recently had a case of bilateral pleural effusion and respiratory distress caused by delayed vascular injury. A 79-y-old Japanese woman was admitted to our hospital because of advanced gastric carcinoma. A multiple-lumen CVC was placed through the left subclavian vein 1 d before surgery for postoperative nutritional management. The patient suddenly complained of dyspnea, and the chest X-ray film revealed right massive pleural effusion. Although the patient's symptoms soon disappeared after the thoracentesis, she again developed severe respiratory distress, and an endotracheal intubation was performed and her respiration was managed by mechanical ventilation. Computed tomographic scan of the chest revealed a displacement of the tip of the CVC out of the wall of the superior vena cava, mediastinitis, and leakage of intravenous fluid, which may have been caused by delayed vascular injury due to the CVC. The CVC was removed immediately after the diagnosis of delayed vascular injury at 10 d after surgery. The patient soon recovered with conservative treatment and was discharged from the hospital 43 d after surgery. This case highlights an extremely rare presenting complication of CVC placement and total parenteral nutrition.

Percutaneous endoscopic gastrostomy for gastric decompression after repeated intestinal obstruction after open abdominal surgery.

In patients with repeated intestinal obstructions after open abdominal surgery, aerophagia associated with disturbances in gastrointestinal passage causes the accumulation of large amounts of air, resulting in chronic symptoms including abdominal pain and distention and consequently malnutrition. We successfully used percutaneous endoscopic gastrostomy (PEG) for long-term gastric decompression in 2 cases with aerophagia. The first case was a 69-year-old Japanese man admitted for repeated intestinal obstruction after an appendectomy. After the last surgery for intestinal obstruction, the patient experienced repeated abdominal distention and anorexia, resulting in weight loss and malnutrition. The second case was a 79-year-old man complaining of abdominal pain and distention. He had a history of resection of the lower pharynx and larynx owing to total laryngectomy and had received a permanent tracheostomy. He then underwent surgery for intestinal obstruction. Because the patients' abdominal symptoms were unresponsive to administration of a peristalsis stimulant and a laxative, we performed PEG to deflate the gastrointestinal tract. An abdominal x-ray taken after the PEG placement showed the elimination of the gas and a remarkable improvement in the gastric dilatation, and the abdominal symptoms soon disappeared. These cases highlight the clinical importance and usefulness of PEG for gastric decompression in patients with aerophagia associated with repeated intestinal obstruction.

Pneumatosis cystoides intestinalis associated with massive free air mimicking perforated diffuse peritonitis.

While pneumatosis cystoides intestinalis (PCI) is a rare disease entity associated with a wide variety of gastrointestinal and non-gastrointestinal disorders, PCI associated with massive intra- and retroperitoneal free air is extremely uncommon, and is difficult to diagnose differentially from perforated peritonitis. We present two cases of PCI associated with massive peritoneal free air and/or retroperitoneal air that mimicked perforated peritonitis. These cases highlight the clinical importance of PCI that mimics perforated peritonitis, which requires emergency surgery. Preoperative imaging modalities and diagnostic laparoscopy are useful to make an accurate diagnosis.

Changes of gene expression of thymidine phosphorylase, thymidylate synthase, dihydropyrimidine dehydrogenase after the administration of 5'-deoxy-5-fluorouridine, paclitaxel and its combination in human gastric cancer xenografts.

BACKGROUND: Although a variety of combination chemotherapies has been tested in gastric carcinoma, the most effective chemotherapeutic regimen and the precise mechanisms underlying anticancer agent combination have not yet been sufficiently elucidated. MATERIALS AND METHODS: Experimental chemotherapy was performed using human gastric carcinoma xenografts, MKN-45 and TMK-1, to examine the anticancer effects and gene expressions of the enzymes involved in 5-fluorouracil metabolism, thymidine phosphorylase (dThdPase), thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD). Nude mice were treated with 5'-deoxy-5-fluorouridine (5'-dFUrd), or paclitaxel alone or in combination. The in vivo antitumor effects on gene expressions of the enzymes were examined using the quantitative real-time RT-PCR method. RESULTS: The combined use of 5'-dFUrd and paclitaxel showed additive to synergistic antitumor effects on both gastric cancer xenografts. There were significant differences of the gene expressions of dThdPase, TS, and DPD between the xenografts. The expression of dThdPase mRNA was consistently up-regulated by the administration of paclitaxel, while no constant direction of TS mRNA and DPD mRNA change was found in the xenografts. CONCLUSION: A synergistic antitumor effect of the combined administration of 5'-dFUrd and paclitaxel was found in gastric cancer xenografts and up-regulation of dThdPase mRNA may be an important underlying mechanism especially in tumors with high gene expression of this enzyme.

[Predictive value of orotate phosphoribosyltransferase in chemoresistant patients with gastric carcinoma who underwent S-1-based neoadjuvant/adjuvant chemotherapy].

S-1, a most effective DPD-inhibitory fluoropyrimidine, used as neoadjuvant/adjuvant chemotherapy has recently been shown to improve clinical outcome in patients with stage II and III advanced stage gastric carcinoma. Orotate phosphoribosyltransferase(OPRTEC 2.4.2.10)is a primary enzyme involved in the first-step phosphorylation process of 5-fluorouracil and is an important enzyme that possibly enables to predict sensitivity to S-1 irrespective of tissue DPD levels. To test the hypothesis that a low OPRT level in gastric carcinoma tissue is an indicator of chemoresistance to S-1-based chemotherapy, the predictive value of OPRT levels in chemoresistance was evaluated in patients with gastric carcinoma undergoing S-1-based-neoadjuvant/adjuvant chemotherapy using survival analyses. A total of 67 patients with advanced-stage gastric carcinoma who underwent S-1-based neoadjuvant/adjuvant chemotherapy were subjected to the study. The OPRT level was determined by an enzyme-linked immunosorbent assay(ELISA)that has recently been developed. Postoperative cumulative survival rates were determined by the Kaplan-Meier method. The patients who underwent S-1-based adjuvant/neoadjuvant chemotherapy(n=67)were divided into 2 groups using various cut-off values to determine the prognostic significance of the OPRT level. The prognostic significance of OPRT levels was analyzed using Cox's proportional hazard model. The P value of the survival rate between the groups of low and high OPRT levels was the lowest(p=0.0018), when 2.0 ng/mg protein was used as a cut-off value for the OPRT level. The 3-year survival rate of Group L and Group H was 0% and 60%, respectively. In particular, there was a significant difference in the survival rates between Group L and Group H in stage III patients(p<0.05 by logrank test). T he survival rate of Group L(OPRT<2.0 ng/mg protein)was significantly lower than that of group H(OPRT> or =2.0 ng/mg protein)(p<0.05 by logrank test). The multivariate analysis using Cox' proportional hazard model indicated that venous invasion of carcinoma(>v2), lymph node metastasis(>5), and low OPRT level (OPRT<2.0 ng/mg protein) were significant prognostic factors in patients who were underwent S-1-based neoadjuvant/adjuvant chemotherapy. These results suggest that patients with a low OPRT level(OPRT<2.0 ng/mg protein)are non-responders to S-1- based adjuvant/neoadjuvant chemotherapy. The determination of OPRT levels in gastric carcinoma tissue enables to predict the response to S-1-based neoadjuvant/adjuvant chemotherapy.

Effects of combined administration of DPD-inhibitory oral fluoropyrimidine, S-1, plus paclitaxel on gene expressions of fluoropyrimidine metabolism-related enzymes in human gastric xenografts.

BACKGROUND: S-1 is the most effective oral fluoropyrimidine derivative widely used for patients with gastric carcinoma in Japan. Although S-1 plus taxane has been a promising candidate as an effective chemotherapeutic regimen, the mechanisms of its additive or synergistic anticancer effects and changes in gene expression after the administration of these agents have not yet been fully elucidated. METHODS: Experimental chemotherapy was performed using human gastric carcinoma xenografts, MKN-45 and TMK-1, to examine anticancer effects and gene expressions of fluoropyrimidine metabolism-related enzymes including thymidine phosphorylase (TP), thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), and uridine phosphorylase (UP). Nude mice were treated with S-1, paclitaxel, and their combination. After treatment, in vivo antitumor effects of S-1, paclitaxel alone, and their combination and the effects on gene expressions of enzymes involved in 5-fluorouracil metabolism were examined using the RT-PCR method. RESULTS: The combined use of S-1 and paclitaxel showed additive to synergistic antitumor effects on both gastric cancer xenografts. While consistent upregulation of dThPase and DPD gene expression was exhibited after administration of S-1, no further increase of dThPase gene expression after combined use of S-1 with paclitaxel was observed. There was no increase in TS gene expression after the administration of either S-1 alone or paclitaxel alone. CONCLUSION: These results provide some insight into the mechanism and/or rationale underlying the additive to synergistic effect of combined administration of S-1 and paclitaxel in gastric carcinoma.

Levels and expressions of orotate phosphoribosyltransferase in gastric carcinoma and normal gastric mucosa tissues.

BACKGROUND: Orotate phosphoribosyltransferase (OPRT; EC 2.4.2.10), a key enzyme that catalyzes one of the primary steps in the phosphorylation of fluoropyrimidine, was recently recognized as an important enzyme that determines the anticancer effects of the dihydropyrimidine dehydrogenase-inhibitory fluoropyrimidine, S-1. METHODS: Levels of OPRT were examined in 97 gastric carcinoma tissues and 65 normal gastric mucosa tissues obtained from patients with gastric carcinoma. The relation between OPRT levels and clinicopathological variables was evaluated, and correlations of OPRT with thymidylate synthase and dihydropyrimidine dehydrogenase levels in gastric carcinoma tissues were evaluated. RESULTS: Although OPRT levels were high in well-differentiated and localized carcinomas, they were not correlated with other clinicopathological variables or with the pathological stage of gastric carcinoma. Levels of OPRT were significantly higher in gastric carcinoma tissue than in normal gastric mucosa. OPRT levels were not correlated with levels of either thymidylate synthase or dihydropyrimidine dehydrogenase. In samples of gastric carcinoma tissues and normal gastric mucosa tissues obtained simultaneously from 24 patients, no correlation was found between OPRT levels in gastric carcinoma and levels in normal gastric mucosa. CONCLUSION: These results suggest that the OPRT level is significantly higher in gastric carcinoma tissue than in normal gastric mucosa and that the OPRT level in gastric carcinoma is a novel variable that is independent of the levels of other previously known enzymes related to 5-fluorouracil (FU) metabolism.

[Orotate phosphoribosyltransferase levels in gastric carcinoma and normal gastric mucosa - correlation with thymidylate synthase and dihydropyrimidine dehydrogenase levels and the changes after neoadjuvant chemotherapy].

Orotate phosphoribosyltransferase (OPRT, EC 2.4.2.10), a key enzyme that catalyzes one of the primary first-step phosphorylation processes of fluoropyrimidine, has recently been recognized as an important factor that primarily determines the anticancer effects of S-1. The OPRT levels were examined in 97 gastric carcinoma tissues and 65 normal gastric mucosa tissues obtained from patients with gastric carcinoma using a newly-developed enzyme-linked immunosorbent assay. Correlations with thymidylate synthase and dihydropyrimidine dehydrogenase levels and the effects of neoadjuvant chemotherapy were evaluated. The OPRT level in gastric carcinoma tissue was significantly higher than that in normal gastric mucosa. There was no correlation of OPRT level with either TS or DPD levels. There was no correlation of OPRT level between those in gastric carcinoma and those in normal gastric mucosa simultaneously obtained from identical patients. The OPRT levels in patients who underwent neoadjuvant chemotherapy were not different from those without neoadjuvant chemotherapy. These results suggest that activation of fluoropyrimidine mainly occurs in carcinoma tissues and the OPRT levels in carcinoma tissues were not influenced by neoadjuvant chemotherapy with fluoropyrimidine.

Randomized clinical trial of the effects of perioperative use of immune-enhancing enteral formula on metabolic and immunological status in patients undergoing esophagectomy.

BACKGROUND: Although perioperative immune-enhancing enteral formula (IEEF) is effective to decrease the rate of infectious complications, it is not clear whether perioperative use of IEEF decreases the incidence of postoperative complications and improves clinical outcome in patients who have undergone esophagectomy. A prospective randomized clinical trial was performed to examine the effects of perioperative IEEF on nutritional and immunological status in patients with esophageal carcinoma who have been treated with esophagectomy. METHODS: A total of 30 patients were randomly assigned to two groups, each receiving 3 days of preoperative and postoperative enteral nutrition through jejunostomy started within 24 h after operation, either with immune-enhancing enteral formula (group IEEF, n = 16) or with regular polymeric enteral formula (group C, n = 14). Preoperative and postoperative nutritional and immunological parameters and clinical outcome were examined. RESULTS: A significant increase in the serum concentration of ornithine was noted in group IEEF and it peaked at 5 days after surgery. The equivalent values were significantly lower in group C. There was no difference in serum dochosahexaic acid between the two groups. The n-3/n-6 fatty acid ratio in group IEEF was significantly higher than in group C at 7 days after surgery. Peripheral percent lymphocyte fraction and total lymphocyte count in group IEEF were both significantly higher than those in group C. While T cell fraction of peripheral lymphocytes in group IEEF at 3 days after surgery, B cell fraction in group IEEF at 5 and 7 days after surgery was significantly higher than those in group C, suggesting that perioperative IEEF caused a shift towards B cell proliferation. CONCLUSIONS: Perioperative use of IEEF caused a significant increase in the total lymphocyte count at 3 and 5 days after operation and caused a shift toward B cell proliferation, which may possibly be beneficial to decrease the incidence of postoperative infectious complications.

[The advances of laparoscopic treatment for gastric cancer].

Recently, laparoscopic surgery for gastric cancer is very interesting topic in the treatment of gastric cancer. Therefore,many surgeons are attempting laparoscopic surgery. However, the technique of this surgery has never been established yet. From July 1997 to July 2006, we performed laparoscopic surgeries for 420 cases of gastric cancer with lymph node dissection. We have describe our technical advances in laparoscopic treatment for gastric cancer along with the clinical outcomes.

[Clinical and prognostic significance of protein and gene expression of orotate phosphoribosyltransferase in gastric carcinoma].

Although orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-fluorouracil, and therefore it has been shown to be an important enzyme that enables to predict sensitivity to 5-fluorouracil, the clinical and prognostic significance of protein and/or gene expression of OPRT has not been well established in gastric carcinoma. We examined the protein level, and mRNA expression of OPRT in gastric carcinoma tissues and relationships with clinicopathologic factors and prognosis were evaluated. A total of 75 surgically-resected gastric carcinoma tissues were subjected to the study. An enzymelinked immunosorbent assay (ELISA) was used to accurately assess intratumoral OPRT, and gene expressions of OPRT were examined using a real-time PCR method. Survival of patients with gastric carcinoma in relation to OPRT protein levels was analyzed using Kaplan-Meier methods along with log-rank test. The mean value of OPRT was 5.4+/-3.6 ng/mg protein, and it was significantly higher in patients with differentiated-type and invasive-type gastric carcinoma. The prognosis of patients in the high OPRT group was better than for those with low OPRT (p<0.05). There was a significant correlation between OPRT levels measured by ELISA and OPRT mRNA expression (p<0.05). Determination of OPRT levels is a useful tool to predict the biological characteristics of gastric carcinoma and possibly predict sensitivity to fluoropyrimidine-based anticancer chemotherapy,particularly dihydropyrimidine dehydrogenase-inhibitory fluoropyrimidine, in patients with gastric carcinoma.

Effects of long-term continuous use of immune-enhancing enteral formula on nutritional and immunologic status in non-surgical patients.

OBJECTIVE: Although the perioperative use of immune-enhancing enteral formula (IEEF) effectively reduces the rate of infectious complications, whether chronic use of IEEF is beneficial is unknown. A prospective randomized clinical trial was performed to examine the safety and effectiveness of long-term IEEF on nutritional and immunologic status in non-surgical patients receiving total enteral nutrition through the gastrostomy access route. METHODS: A total of 30 patients were randomly assigned to two groups in which they received total enteral nutrition, an IEEF (n = 15) or a regular polymeric enteral formula (control group; n = 15) for 12 wk. Nutritional and immunologic variables were periodically examined. RESULTS: Serum concentrations of insulin-like growth factor-I increased significantly for the IEEF group throughout the study. Although serum concentrations of dihomo-gamma-linoleic acid decreased significantly in the IEEF group, serum concentrations of eicosapentaenoic acid and docosahexaenoic acid increased significantly, as did concentrations of serum arginine and ornithine. The CD4/CD8 ratio and natural killer cell activity also increased for the IEEF group, but the differences were not significant. The B-cell fraction increased and the T-cell fraction of peripheral lymphocytes decreased for the IEEF group. Neither infectious nor non-infectious complications occurred during the study period in either group, except for a significant increase in serum urea nitrogen and uric acid concentrations for the IEEF group. CONCLUSION: Long-term use of IEEF is safe in non-surgical patients and results in a significant increase in serum insulin-like growth factor-I concentrations in association with increased humoral immunity.

Orotate phosphoribosyltransferase levels measured by a newly established enzyme-linked immunosorbent assay in gastric carcinoma.

A number of enzymes have been shown to be involved in the process of activation and/or degradation of 5-fluorouracil (5-FU), and are potential candidates for predicting chemosensitivity to 5-FU. Among these, orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-FU and has been shown to be an important enzyme that helps to predict sensitivity to 5-FU and its related derivatives. We developed a new enzyme-linked immunosorbent assay (ELISA) to accurately assess intratumoral activity of OPRT. A new sandwich ELISA was established using anti-OPRT polyclonal antibodies obtained from the rabbit immunized with the recombinant human peptides of the OPRT molecule. OPRT levels were measured in eight human cancer xenografts and in 75 gastric cancer tissues using both a newly established ELISA and a conventional enzyme assay, using radiolabeled 5-FU as a substrate. There was a significant correlation between OPRT levels measured by this ELISA and OPRT enzyme activity the in eight human cancer xenografts (r2 = 0.782) and gastric carcinoma tissue (r2 = 0.617). The ELISA system for OPRT requires a minimal amount of carcinoma tissue, making it an easy-to-use assay system to predict sensitivity to 5-FU and its derivatives in gastric carcinoma. There was a significant correlation between tumor growth inhibition rates against the oral administration of oral-uracil/tegafur (UFT) and OPRT enzyme activity in the human cancer xenografts (r2 = 0.574). These results suggest that this newly developed sandwich ELISA system for the quantification of OPRT levels is technically simple, feasible and a useful tool to predict sensitivity to fluoropyrimidine-based anticancer chemotherapy in patients with gastric carcinoma and other cancers.

[Clinicopathological significance of orotate phosphoribosyltransferase in gastric carcinoma].

Orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step phosphorylation process of 5-fluorouracil. We have recently developed an ELISA system to measure OPRT levels in cancerous tissues. We examined OPRT levels in 75 gastric carcinoma tissues using this ELISA, and the relationships with clinicopathologic factors were evaluated. A total of 75 surgically-resected gastric carcinoma tissues were subjected to the present study. The intratumoral OPRT level was determined by a newly-developed enzyme-linked immunosorbent assay (ELISA). Enzyme activities of OPRT were also determined using a conventional enzyme assay using radiolabeled 5-fluorouracil as a substrate. OPRT levels in gastric carcinoma tissues measured by ELISA were 5.4+/-3.6 ng/mg protein, ranging from 0.2 to 15.7 ng/mg protein. There was a significant correlation between the OPRT level measured by the ELISA and OPRT enzyme activity (y=0.545x - 0.017, r(2)=0.617, p<0.0001). OPRT levels were significantly higher in patients with differentiated type and invasive type of gastric carcinoma, whereas OPRT levels were not associated with the pathological stage of gastric carcinoma. These results suggest that OPRT levels were related to the histopathological characteristics of gastric carcinoma, and may be related to the response to fluoropyrimidine-based anticancer chemotherapy.

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer.

In order to prevent the Roux stasis syndrome that sometimes follows Roux-en-Y gastrojejunostomy after distal gastrectomy, a new type of reconstruction, called the uncut Roux-en-Y technique, has been reported. We successfully performed 42 laparoscopy-assisted uncut Roux-en-Y gastrojejunostomies. Here we describe our technique and the initial outcome.

[Advancce in laparoscopic treatment for gastric cancer].

Many laparoscopic surgeries for gastric cancer are presented, including D 2 lymphadenectomy, gastrectomy with preservation of vagus nerve and intracorporeal anastomosis after some gastrectomies. The great advances in laparoscopic treatments in gastric cancer are described.