Treatment of peritoneal dissemination of gastric cancer with sequential methotrexate and 5-fluorouracil.

BACKGROUND: Pretreatment with methotrexate (MTX) followed by 5-fluorouracil (5-FU) (sequential MTX and 5-FU), exerts biochemical modulation in which the antitumor effect of 5-FU is enhanced by the preceding MTX. Since the early 1980s, the sequential MTX/5-FU regimen has been employed clinically for gastric cancer in Japan, with high response rates for undifferentiated type gastric carcinoma.METHODS: Peritoneal dissemination is more frequent in undifferentiated type carcinoma, we therefore employed sequential MTX and 5-FU for the treatment of 39 gastric cancer patients with peritoneal dissemination.

Recurrence of convexity meningiomas: tumor cells in the arachnoid membrane.

Background: It remains open to debate why totally removed benign meningiomas recur. Two recurrent cases forced us to reconsider something corresponding to their recurrence that we had overlooked during Simpson grade I surgery.

Methods: This study is based on 24 recent and 9 earlier cases in which benign convexity meningiomas were totally removed by Simpson's grade I surgery.

Saccular cerebral aneurysms in young adults.

Background: The formation and rupture of cerebral aneurysms has been controversial. In order to clarify their nature, this study investigates the size and location of ruptured and unruptured aneurysms in young adults and the results of surgery.

Methods: The subjects of this study are 35 patients with ruptured and two with unruptured aneurysms.

Ethanol improves decreased filterability of human red blood cells through modulation of intracellular signaling pathways.

Background: Deformability of red blood cells (RBCs) is one of the most important factors in maintaining the microcirculation system. In vitro studies have revealed that ethanol seriously impairs the deformability of RBCs at concentrations far higher than those easily achievable in the blood after alcohol consumption. We examined the effect of ethanol on deformability at the physiologically achievable concentrations.

Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.

Background: Three hundred and forty-five patients who underwent urgent colonoscopy for acute hematochezia during the past 20 years (from 1976 to 1995) were retrospectively analyzed.

Methods: Urgent colonoscopy was defined as endoscopy performed within 24 h after a bleeding episode. Preparation was initially minimal with a water or glycerine enema.

Secretory granules of pituitary adenomas: quantitative study of hormonal antigenicity.

Ultrastructurally, the antigenicity of major pituitary hormones in secretory granules was quantitatively investigated in five growth hormone (GH)-secreting adenomas, five prolactin (PRL)-secreting adenomas and eight clinically non-functioning (CN-F) adenomas. Sparsely granulated cells with a few or several small secretory granules (60-100 nm) exhibiting little or only weak antigenicity of various biochemically unrelated hormones were commonly observed in CN-F adenomas and occasionally in GH- and PRL-secreting adenomas. GH- or PRL-secreting adenomas consisted of many densely granulated cells with medium-sized (200-250 nm) or large (over 250 nm) secretory granules and a few or several sparsely granulated cells with small secretory granules.

Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis.

Background: Insulin resistance contributes to the pathogenesis of atherosclerotic cardiovascular disease and, thus, has an important impact on the mortality of uraemic patients. Haemodialysis (HD) is known to improve insulin resistance observed in uraemia. However, it is not known whether continuous ambulatory peritoneal dialysis (CAPD) alleviates insulin resistance in adult uraemic patients.

[Twenty-five years of progress in the treatment of esophageal and gastric cancers].

As we approach the year 2000, it seems useful to look back at the progress that has been made in medicine. The author has had 25 years' experience in gastrointestinal surgery for esophageal and gastric cancers. Twenty-five years ago in the field of gastrointestinal cancer diagnosis, double-contrast radiography was the leading technology and the development of fiberscopes led to an increasing number of early cancers being detected by endoscopy combined with biopsy.

[Recent advances in radiofrequency catheter ablation for atrial fibrillation].

Failure to control the ventricular rate in atrial fibrillation (AF) can be treated by radiofrequency (RF), ablation or modification of atrioventricular (AV) node. AV nodal ablation with pacemaker and AV nodal modification are associated with significant improvement in symptoms and quality of life. But there is no evidence that these techniques influence survival, and in some cases these therapies must be followed by implantation of a permanent pacemaker (due to complete AV block), and anticoagulation (due to persistence of underlying AF).

Endothelin-1 improves the impaired filterability of red blood cells through the activation of protein kinase C.

We previously showed that the deformability of human red blood cells (RBCs) is affected by intracellular signaling pathways by examining the effects of Ca2+ influx and the intracellular cAMP level on mechanically-impaired RBC filterability. In the present study, we investigated whether protein kinase C (PKC) participates in the regulation of RBC deformability by affecting membrane properties. The filterability of mechanically-stressed RBCs showed a V-shaped curve depending on the extracellular Ca2+ concentration; the maximum decrease was achieved at 20-40 microM.

Bleeding risk in unruptured and residual cerebral aneurysms--angiographic annual growth rate in nineteen patients.

Whether and when unruptured aneurysms or aneurysmal rests following incomplete surgery result in subsequent bleeding are major concerns for neurosurgeons. By calculating the annual growth rate of aneurysms in long-term follow-up angiography (partly supplemented with MR-imaging and/or MR-angiography), we attempted to determine the surgical indications for these aneurysms. Long-term follow-up angiography ranging from one to 20 years was carried out on five patients whose ruptured aneurysms had been incompletely occluded, six patients with multiple aneurysms, of which the ruptured ones had been completely obliterated at operation and the small unruptured aneurysms, missed or misdiagnosed, and eight patients with unruptured aneurysms which were asymptomatic or symptomatic.

[Improving the anti-tumor activity of 5-fluorouracil by methotrexate].

The first clinical application of biochemical modulation (BCM) of 5-fluorouracil (5-FU) was the sequential MTX/5-FU regimen proposed in 1977 by Bertino for the treatment of colorectal cancer. In Japan, sequential MTX/5-FU therapy was mainly used as a new method of treating gastric cancer, and attracted a great deal of attention because it proved effective in many cases of advanced gastric cancer that had been unresponsive to the previous chemotherapy, particularly scirrhous gastric cancer with poor prognosis. Its therapeutic efficacy varied according to histologic type, it was effective in cases of peritoneal dissemination and disseminated intravascular coagulopathy (DIC), it was associated with fewer adverse effects, and it was a multidrug chemotherapy based on a clear rationale.

[Hemodynamic evaluations of patients with small aortic annulus with St. Jude Medical prosthetic heart valve].

As the elderly population in Japan increases, senile degenerative aortic valvular disease also tends to increase. These patients often have a small aortic annulus. The problem of "valve-patient-mismatch" occurs when a small prosthesis is inserted into a patient with a small aortic annulus.

[Experience and clinical usefulness of BACTEC MGIT 960].

Recently, an automatic instrument for culturing acid-fast bacteria in liquid media has been introduced in Japan to accelerate and increase the detection of the bacteria as well as the work e ciency of test lab technicians. We compared the MGIT (Mycobacterium Growth Indicator Tube) method and the two conventional culture methods used in our lab by testing 176 specimens (130 cases) submitted for acid-fast testing between July 27 and September 18, 1998. BACTEC MGIT 960 (Nippon Becton Dickinson) was used in the MGIT method while Ogawa K medium and Kudo PD medium were used for our conventional culture methods.

The pattern of antiganglioside antibody reactivities producing myelinated nerve conduction block in vitro.

We studied the pattern of human antiganglioside antibody reactivities causing an acute conduction block in rat myelinated nerve fibers, using an in vitro preparation of the sciatic-tibial nerve. With the aid of complements, IgM antibodies reacting with the terminal disaccharide of galactose (beta1-3)N-acetylgalactosamine produced the block. These findings may help us to understand the mechanism in which the conduction block occurs in neuropathies associated with antiganglioside antibodies.

The multihormonal character of pituitary adenomas: immuno-electron microscopic studies.

This study investigates the multihormonal character of pituitary adenomas at the ultrastructural level. The growth hormone (GH)- and prolactin (PRL)-secreting adenomas under study consisted of many moderately or densely granulated cells and a few sparsely or slightly granulated cells. The GH-secreting adenomas showed well-developed cytoplasmic organelles and many large (250 nm or more) or medium-sized (200 nm) secretory granules, as well as a few small (70-150 nm) secretory granules.

[Mediastinal germ-cell tumor associated with AML (M7)--the syndrome of mediastinal germ-cell tumors associated with hematologic neoplasia?].

In October 1992, a 36-year-old man was diagnosed as having mediastinum mixed germ cell tumor (stage II), and was treated with surgical operation and combination chemotherapy including VP16 (total VP16 dose; 1,500 mg/m2). After that, remission had been sustained, but leukocytosis (15,700/microliter) with 37% of peroxidase-negative blasts and thrombocytopenia developed in September, 1995. Bone marrow showed remarkable reticulin fibrosis and increase of atypical immature cells that were immunophenotypically factor VIII+/CD42+/CD61+.

Production of prostaglandins E1 and E2 by adult human red blood cells.

We showed that human adult red blood cells (RBCs) produce prostaglandin E1 (PGE1) and E2 (PGE2). RBCs that were mechanically stressed in the presence of extracellular Ca2+ by being injected rapidly through a fine needle produced PGE1 and PGE2 within 30 min after this mechanical stress. The amounts of PGE1 and PGE2 produced by 1 x 10(9) mechanically stressed RBCs were approximately 50 pg and 100 pg, respectively, which were determined in the cytosolic fraction from sonicated RBCs using a competitive enzyme immunoassay method.

[Drug-associated hemorrhagic enteritis].

Drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (AAHC) and other drug associated hemorrhagic colitis. AAHC are mainly caused by oral usage of Ampicillin and its derivatives (85%). Initially AAHC are believed to be caused by Klebsiella oxytoca overgrowth.

[Does mixed venous desaturation during a bed bath indicate cardiopulmonary decompensation in postoperative cardiac patients?].

The bed bath procedure consists of cleansing patients' body, passive position change, changing gown and making a bed. During the procedure, mixed venous desaturation was observed consistently in postoperative cardiac patients. We investigated the cause of the phenomenon in 22 patients undergoing cardiac surgery in their first postoperative day.

Strict dietary sodium reduction worsens insulin sensitivity by increasing sympathetic nervous activity in patients with primary hypertension.

To assess the effects of sodium reduction on insulin sensitivity in hypertension, we examined the change of insulin sensitivity after two degrees of dietary sodium restriction by the euglycemic hyperinsulinemic glucose clamp method in 12 subjects with primary hypertension. A controlled period of 1 week, when the subjects were taking a normal sodium diet, was followed by a randomized crossover study in which the subjects were placed on either moderate or strict reduced sodium diets for 1 week. The result of the 1-week moderate dietary sodium reduction from 200 to 100 mmol/day showed significant decreases in systolic and diastolic blood pressure by 6.