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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Our previous study demonstrated that soluble CD14 (sCD14) modulates the biologic activity of circulating endotoxin, which appears after surgery. In this study, we examined the behavior of endotoxin-binding proteins, such as sCD14, lipopolysaccharide-binding protein (LBP), and bactericidal/permeability-increasing protein (BPI), in patients' plasma after major abdominal surgery and the phagocytic secretion of sCD14 from peripheral blood mononuclear cells (PBMCs) throughout the observation period. In a prospective study, 15 patients undergoing major abdominal surgery (gastrectomy, n= 3; pancreatectomy, n= 10; colectomy, n= 2) were involved in this study. The endotoxin-binding proteins were perioperatively (preoperatively; postoperative hour 6; days 1, 2, 3, 4, 5, 7, and 10) measured by an enzyme-linked immunosorbent assay (ELISA). To exclude the hemodilution effect of samples, each parameter was corrected by dividing the respective value by the albumin concentration. The phagocytic activity at each time point was tested as an ex vivo sCD14 secretion from PBMCs in the presence and absence of exogenously added endotoxin, Escherichia coli 055B5 (1 ng/ml). Significant endotoxemia (0.35 ± 0.13 EU/ml; p 〈 0.05) was observed 6 hours after the beginning of surgery. The sCD14/albumin value rapidly increased at 6 hours after surgery, peaked on day 1, and sequentially declined, whereas the BPI/albumin and LBP/albumin ratios increased more gradually and peaked on day 2. The secretion of sCD14 from 2 × 106 PBMCs was significantly enhanced from 6 hours after operation. The increased plasma level of sCD14 may be explained by the parallel-enhanced sCD14 PBMC production. Activated secretion of these endotoxin-binding proteins may play a role in regulating the biologic activity of circulating endotoxin.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: n = 16); intraoperative chemotherapy and UFT 300 mg/day (P1 group, n= 13); or UFT 600 mg/day (P2 group, n= 17). Patients with an intestinal type of cancer were randomly assigned to one of three treatment groups: H0 (n= 17), H1 (n= 12), and H2 (n= 12); each group was subjected to the same protocols as the P0, P1, and P2 groups, respectively, except for the MMC administration route. MMC (10 mg/patient) was administered intraoperatively into the intraperitoneal cavity (P1 and P2 groups) or the portal vein (H1 and H2 groups). All patients underwent curative resection. Background factors did not differ significantly among the treatment groups. The overall survival rates were progressively worsened in the order of P2, P1, and P0 or H2, H1, and H0, respectively. The survival rate of the P2 group was statistically higher than that of the P0 group (p 〈 0.05). The intermediate-term survival rate of the P2 group or H2 group was significantly higher than that of the P0 group (p 〈 0.05) or H0 group (p 〈 0.05), respectively. These results suggest the effectiveness of this therapy and the possible eradication of potential micrometastatic foci outside the surgical field by the direct administration of chemotherapeutic agents to the predicted recurrence site.
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  • 3
    ISSN: 1440-1681
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: 1. The effects of ischaemic preconditioning (IP) on renal function, haemodynamics and lipid peroxidation in the rat ischaemia–reperfused kidney model were examined.2. In Wistar male rats, application of a single or three periods of 5 min bilateral renal ischaemia was performed prior to 30 min bilateral ischaemia and 90 min reperfusion (IR). The glomerular filtration rate (GFR) was estimated in terms of inulin clearance. Fractional excretion of sodium (FENa) and lithium (FELi), indicating total and proximal tubular sodium handling, respectively, was also measured and renal blood flow was monitored throughout the experiment. In addition, renal lipid peroxidation (LPO) levels in reperfused kidneys were evaluated.3. A 2.8-fold increase in recovery of GFR (P 〈 0.005), a 50% reduction in FENa (P 〈 0.005) and a 40% decrease in FELi (P 〈 0.05) after IR resulted from the single period of 5 min IP. Renal blood flow was also higher than that in the control group (P 〈 0.01). No change of LPO levels was observed.4. We conclude that IP may have an ability to ameliorate reperfused renal function and haemodynamics with a suitable period of preconditioned ischaemia, although this effect is independent of LPO.
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  • 4
    ISSN: 1432-1335
    Keywords: Key words Gastric cancer ; Angiogenic factor ; Angiogenin ; Proteolysis ; Enzyme-linked immunosorbent assay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: The purpose of this study is to elucidate the expression of angiogenin and its previously undemonstrated clinical significance in gastric cancer (GC). Methods: Angiogenin expression was examined immunohistochemically in 21 GC tissues and 21 corresponding normal gastric tissues. The serum concentration was determined by enzyme-linked immunosorbent assay (ELISA) in GC patients preoperatively (n=48) and postoperatively (n=41), in nonneoplastic patients preoperatively (n=23) and postoperatively (n=19), and in 32 healthy volunteers. The amount of angiogenin in the tissue of 21 GC patients was also determined by ELISA. Results: Angiogenin expression was observed in GC cells as well as in some fundic glandular cells and some inflammatory cells. The mean serum concentration in GC patients (407.8 ± 105.2 ng/ml) was significantly higher than that in the nonneoplastic patients (345.7 ± 58.3 ng/ml; P 〈 0.003) and in the healthy volunteers (333.0 ± 59.3 ng/ml; P 〈 0.0002). The mean serum angiogenin concentrations were progressively higher in the order T1+T2 (P 〈 0.04) 〈 T3+T4 (P 〈 0.0001) 〈 recurrent GC (P 〈 0.05) subgroups, in the order node-negative (P 〈 0.05) 〈 node-positive (P 〈 0.0002) subgroups, and in the order stage I+II (P 〈 0.02) 〈 stage III and over (P 〈 0.0005) subgroups as compared with those in the healthy volunteers. These elevated serum angiogenin concentrations in each subgroup were significantly (P 〈 0.0003) reduced after cancer resection. The amounts of angiogenin in GC tissues correlated significantly with the serum angiogenin concentration (P 〈 0.01). Conclusions: These results suggest that angiogenin expression is increased in GC and that the increased serum concentration in GC patients correlates with cancer progression.
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  • 5
    ISSN: 1530-0358
    Keywords: Adenoma ; Colon: Depressed lesion ; Colonoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To clarify the presence of depressed adenomas in the human large intestine, a prospective study was performed from January 1986 to December 1987. During these two years, 997 colonoscopies were conducted in patients, bdexcluding cases of familial adenomatosis coli. Of 32 small, depressed lesions biopsied, seven were depressed adenomas, demonstrating that depressed adenomas do exist in the colon and rectum, and can be detected endoscopically. Resembling a sucker, they are easily detected through inflation and deflation.
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  • 6
    ISSN: 1530-0358
    Keywords: Colon ; Flat cancer ; De novo ; Cancer development ; Colonoscopy ; Depressed cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE AND BACKGROUND: Qualitative and quantitative analysis of many flat early cancers that have been discovered during the last decade led us to recognize that a flat route of cancer development de novo is as important a route as the polypoid one. We aim to prove through a longitudinal study that these flat early cancers indeed develop in flat mucosa and not in an adenomatous polyp. METHODS: From January 1, 1990, to July 31, 1994, 554 patients underwent at least two colonoscopies. These patients consisted of 364 males, and average age was 59 years. We searched for flat early cancers developing in polyp-free colorectal mucosa on or after a second colonoscopy. Polyp-free mucosa here means an intestinal segment proved to possess no adenomatous polyp during the preceding colonoscopies, irrespective of the presence of polyps else-where. RESULTS: Four flat early cancers were found developing in polyp-free colonic mucosa in four patients. Average age of the patients was 67 years. Locations of the cancers were the transverse (3) and descending colons (1). The shapes were all depressed, and average size of the lesions was 11 mm. Two lesions were endoscopically resected, and two by surgery. CONCLUSION: These four depressed cancers developing in polyp-free mucosa show that flat early colorectal cancers do arise de novo and not from an adenomatous polyp having collapsed on itself.
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  • 7
    ISSN: 1530-0358
    Keywords: Peutz-Jeghers syndrome ; Appendix ; Hamartoma ; Pancreas ; Duodenum ; Cancer ; Intussusception
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The unusual occurrence of an “inside-out” appendix reported here is a case of complete intussusception of the appendix of a 45-year-old woman with Peutz-Jeghers syndrome in whom the diagnosis of intussusception was made preoperatively. At laparotomy, the lead point of intussusceptum was revealed to be a Peutz-Jeghers syndrome polyp of the appendix. There was also a cystic lesion in the pancreas, and subsequent distal pancreatectomy revealed a cystadenocarcinoma of the pancreas. Two jejunal Peutz-Jeghers syndrome polyps and two duodenal Peutz-Jeghers syndrome polyps were foundvia intraoperative endoscopies. The duodenal polyps were endoscopically removed, whereas a jejunal wedge resection was performed for the adjoining jejunal polyps. One of the two duodenal polyps possessed an adenocarcinoma focus. To our knowledge, this is the first report of complete intussusception of the appendix caused by a Peutz-Jeghers syndrome polyp.
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  • 8
    ISSN: 1534-4681
    Keywords: Early gastric cancer ; Peptic ulcer ; Intestinal metaplasia ; Carcinogenesis ; Growth factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Early gastric cancer (EGC) often coexists with peptic ulcer. In this study we investigated the roles of peptic ulcer in the carcinogenesis and extension of gastric cancer. Methods: The clinicopathological characteristics of EGC and peptic ulcer and their relationship, as well as that of the background intestinal metaplasia, were compared among the following three groups: patients with peptic ulcer only inside the EGC (Contained group, 53 patients); patients with peptic ulcer only outside the EGC (Separate group, 26 patients); and patients of EGC with no peptic ulcer (Absent group, 43 patients). Results: In the Separate group, a male preponderance was observed (P = .006), and all EGCs developed in the middle or lower third of the stomach (P = .06). Most of the EGCs were an intestinal type of cancer with severe background intestinal metaplasia. Topographically, 88% of the peptic ulcers in the Separate group developed proximal to the EGC. On the other hand, in the Contained group, most EGCs developed in the middle third of the stomach with an intestinal/diffuse type ratio of 1:1. Peptic ulcers inside the EGC were significantly more shallow than those that developed outside the EGC (P = 0.008). Although the incidences of submucosal cancer were nearly the same among the three groups, the maximum cancer diameter tended to be increased in the Contained group compared to that in the Absent group, and the incidence of lymph node involvement tended to be higher in the Contained group (8%) as compared with the other two groups (4%–5%). Conclusions: These results suggest that peptic ulcer outside the EGC contributes to the development of the intestinal type of EGC, with the background of more severe intestinal metaplasia during the peptic ulcer healing processes, whereas peptic ulcer inside the EGC develops secondary to EGC and favors cancer extension and metastasis. Peptic ulcer associated with EGC can be considered to exert different biological roles in the carcinogenesis or extension of ECG according to the location of the peptic ulcer.
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  • 9
    ISSN: 1436-3305
    Keywords: Key words: human differentiated gastric cancer, differentiation phenotype, phenotypic change, intestinalization, preneoplastic lesion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Background. The phenotypic expression of tumor cells is widely thought to resemble that of the tissue of origin. In the present study, to assess phenotypic changes that occur with disease progression, we investigated human differentiated gastric cancers at different depths of invasion for component cancer cell types. Methods. Using a combined mucin histochemical and immunohistochemical approach, we classified surgical specimens of 301 differentiated gastric cancers into three types: gastric epithelial cell (G) type, intestinal epithelial cell (I) type and mixed gastric and intestinal (GI) type, according to the phenotypic differentiation of the component cancer cells. The relation between the phenotypic type of cancer and their depth of invasion was evaluated. Results. The proportion of G type cancers was 41.4% in early (tumor invasion of mucosa or submucosa) cases, decreasing to 22.2% in advanced (tumor invasion of muscularis propia or deeper) cases, whereas the proportion of I type cancers increased with progressive disease from 23.5% to 31.1% (P 〈 0.01). Cancers invading the subserosa or deeper included more I type cases and fewer G type than cancers limited to the mucosa (P 〈 0.01). In most cases of each phenotypic type, intestinal metaplasia was recognized in the surrounding background mucosa, but no clear relation was shown between the phenotype of cancers and the degree of intestinal metaplasia in the background mucosa, suggesting that intestinal metaplasia is not always a preneoplastic lesion. Conclusions. A phenotypic shift from G to I type expression was observed with the progression of human differentiated gastric cancers. Intestinalization may occur independently in cancerous and noncancerous gastric mucosa.
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  • 10
    ISSN: 1436-2813
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We investigated the functional and morphological aspects of acid secretion in 6 patients with post-bulbar duodenal ulcer and compared the findings with the events of 40 patients with the usual chronic duodenal ulcer. The post-bulbar ulcer patients showed a much higher acidity, and a biphasic, prolonged acid secretion pattern, presumably representing an enhanced parietal cell function. Histological study of antrectomized specimens revealed that 4 of those with the post-bulbar ulcer had a small antrum in which the fundic gland area expanded distally. The proximal border of the pyloric gland area was within 4 cm of the pylorus. This would suggest the presence of a large parietal cell mass. On the contrary, however, there was no such instance in those patients with the usual duodenal ulcer. Hyperacidity, due to a large parietal cell mass and an enhanced parietal cell function, may play an important role in the pathogenesis of post-bulbar duodenal ulcer.
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