Endoscopic and clinicopathological features of primary gastric lymphoma.

Thirty-three patients with primary gastric lymphoma over a period of 32 years were studied. Endoscopic findings indicated that there were many cases of multiple lymphoma in the stomach, or with extensive tumor-infiltration, and that it was necessary to carefully inspect the entire stomach to determine the scope of resection and improve diagnostic accuracy. It is also particularly important not to damage the tissue during biopsy and to take deep large specimens from the ulcer margin, surrounding wall, and area of erosion. As compared clinicopathologically with gastric carcinoma, primary gastric lymphoma is found more frequently in younger females, with invasion of the entire stomach and extensive lymph node infiltration. By performing adequate resection of lymph nodes, as is done for gastric carcinoma, and administering appropriate combination chemotherapy, postoperative longterm results were similar to, or better than, those obtained with gastric carcinoma.

[The influence of sleep breathing disorder on growth hormone secretion in children with tonsil hypertrophy].

INTRODUCTION: Recently it has been revealed that Obstructive Sleep Apnea Syndrome has an influence on the endocrine system, especially to the secretion of growth hormone (GH). It was previously reported that secretion of GH has a circadian rhythm along with a correlation with slow wave sleep. Normally in a pediatric patient, after 90 min of sleep the brain wave shows patterns of deep sleep, and a matching peak in GH secretion is observed. We have studied the effect of GH secretion in sleep breathing disorder of pediatric patients by observing the pre- and post-operative difference in GH secretion in children with tonsillar hypertrophy who had tonsillectomies. MATERIAL AND METHODS: Ten pediatric patients who complained of sleep apnea or hypopnea, and were highly suspected of having sleep breathing disorders due to tonsil hypertrophy and underwent surgery were chosen. Pre and post-operative blood somatomedin C and urinary growth hormone levels were measured. In 6 of the 10 patients blood GH levels were measured after overnight collection of blood every 30 min through a catheter placed in the vein. METHOD OF ANALYSIS: Integral blood GH calculated from GH levels of the blood samples taken every 30 min was used to express the efficacy of GH secretion during sleep, and was compared with blood somatomedin C and urinary GH levels. Pre- and post-operative somatomedin C and urinary GH measurements were compared. RESULT: 1) In 6 of the 10 patients, there was a positive correlation with integral GH and urinary GH, and no correlation with integral GH or somatomedin C. 2) Post-operatively, 7 of the 10 patients had increased urinary GH levels, 1 showed no change and 2 had decreased levels. There was a significant increase in the mean urinary GH levels from 18.6 +/- 16.1 pg/ml pre-operatively to 35.8 +/- 19.6 pg/ml post-operatively (P < 0.05). 3) Eight of the 10 patients had a post-operative increase in somatomedin C levels, 1 showed no change and the other patient had a decreased level. There was a significant increase in mean somatomedin C levels from 175.9 +/- 124.8 ng/ml pre-operatively to 226.6 +/- 134.3 ng/ml post-operatively (P < 0.01). CASE: An 8-year-old-boy was diagnosed as having habitual tonsillitis and suspected sleep breathing disorder, and was admitted to our hospital for a tonsillectomy. Apnea and hypopnea were observed during sleep in the hospital. After receiving his parents' consent, GH secretion was evaluated before and after the tonsillectomy. Integrated GH measurements, somatomedin C and urinary GH increased significantly after the operation. CONCLUSION: In this study, the improvement of sleep breathing disorder by surgery was associated with a positive effect to the GH secretion. GH secretion is important for growth of a child. Wen the cause of sleep breathing disorder is evident in the upper airway system, active treatment and cure by surgery is advised. Measurement of urinary GH in the morning is useful and simple for evaluating the ability to secrete GH.

Changes in delayed hypersensitivity reaction in mice exposed to O3.

BALB/c mice were continuously exposed to 0.8 ppm O3 for 1, 3, 7, and 14 days. Ozone exposure suppressed the delayed hypersensitivity (DH) reaction to sheep red blood cells (SRBC). The maximum effect was seen after 7 days of exposure. To estimate the suppression of the DH reaction by O3 exposure, the numbers of lymphocytes in thymus and blood of exposed mice were compared with those of control mice. A decrease in the numbers of lymphocytes in both thymus and blood was observed in O3-exposed mice. The percentage of T and B lymphocytes in blood of exposed mice was the same as that in blood of control mice. These results suggest that 0.8 ppm O3 exposure affects the T lymphocytes required for DH reactions.

Induction of IgE antibody production to aerosolized ovalbumin in mice treated intratracheally with aluminum silicate.

Induction of IgE antibody production was studied in mice with aerosolized antigen exposure and intratracheal instillation of adjuvants. BALB/c mice were immunized intratracheally with 10 micrograms ovalbumin (OA) adsorbed with or without aluminum silicate as an adjuvant. A primary IgE antibody production was observed in mice immunized with OA plus adjuvant, but not with OA alone. In mice immunized with OA plus adjuvant, a secondary IgE antibody production was observed after a booster of OA aerosol exposure on day 28. Mice were instilled intratracheally with aluminum silicate or aluminum hydroxide (alum) and subsequently exposed to aerosolized OA for 30 min. Primary and secondary anti-OA IgE antibody productions were obtained in the groups instilled with the adjuvants. After the intratracheal instillation of alum, aluminum remained in the mice for a long period. These results suggest that the intratracheal instillation of adjuvants is effective in the induction of IgE antibody production by aerosolized antigen exposure.

Clinicopathologic features of gastric cancer infiltrating the lower esophagus.

A total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc-phytate) uptake testing revealed that it was important to dissect the lymph nodes (predominantly nodes 7, 9, 11, and 16) during surgery in the patients with gastric cancer plus esophageal infiltration. When cancer infiltration of the esophagus exceeds 1 cm, the preferred surgical procedure is lower esophagectomy and total gastrectomy with abdominal and intrathoracic lymphadenectomy via the left thoracoabdominal approach. When residual cancer is suggested in the more proximal esophageal stump due to intramural metastasis from vascular invasion, rapid pathologic diagnosis should be made by frozen sections during surgery and then subtotal esophagectomy by blunt removal of the esophagus proximally from the aortic arch using a left thoracotomy considered.