Morphologic alterations in the gastric microcirculation in cirrhosis were investigated following infusion of a silicone rubber compound into vessels of the excised stomach which was then cleared with methyl salicylate. In cirrhosis, arteriovenous anastomoses 15 to 50 micron in diameter were present in 5 of 10 patients; spiral arterioles were less than one-tenth as numerous as in stomachs from noncirrhotic patients. The arterioles mainly had a straight pattern and precapillaries, capillaries, and submucosal and subserosal veins were dilated in cirrhotics (p less than 0.05). The number of arteriovenous anastomoses was unrelated to the degree of vascular dilatation and the number of spiral arterioles. These morphological alterations are consistent with decreased arteriovenous flow resistance in the stomach of cirrhotic patients.

Adult↗

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Developments in the treatment of gastric cancer.

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Humans↗

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Prolonged survival of stomach cancer patients after extensive surgery and adjuvant treatment: an overview of the Japanese experience.

The 5-year survival rate of resected stomach cancer patients, which had been nearly 20% or less in the 1950s, has now been increased to more than 60%. Such a remarkable improvement was analyzed from the data of the National Registry or of the nationwide cohort studies. Standardization of the operative method involving extensive lymph node dissection, which has prevailed since the mid-1960s, was the leading factor in this improvement. Development of improved techniques for early diagnosis increased the rate of detection of early cancer and the rate of early cancer per resected cases amounts to more than 30% in major institutions as of 1981. Adjuvant chemo-immunotherapy administered over a long postoperative period was confirmed to elevate the cure rate substantially. As new anticancer drugs recently developed in Japan, UFT (Uracil/Tegafur mixture) and HCFU (Carmoful) were introduced. Optional use of regional therapy such as arterial infusion chemotherapy or intracavital biological response modifiers (BRM) injection are among the latest treatment possibilities.

Antineoplastic Combined Chemotherapy Protocols↗

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Arterial hypoxemia in patients with hepatic cirrhosis.

Pulmonary function tests were studied in 105 patients with cirrhosis of the liver who had no clinical or radiographical evidence of cardiopulmonary disease. Spirometric data such as VC, FRC, RV, TLC, RV/TLC and FEV1.0% were within normal limits in all subjects. However, flow-volume curve and closing volume curve were abnormal in the majority. In flow-volume curve, V25, was decreased and the V50/V25 value was increased; on the other hand, closing volume was markedly increased and FRC-CC value was reduced in the patients with hepatic cirrhosis. The closing capacity tended to exceed the FRC in the patients with arterial hypoxemia, indicating the presence of airway closure and gas trapping during resting ventilation. Therefore, ventilation-perfusion imbalance may be an important cause of arterial hypoxemia in patients with cirrhosis of the liver.

Adult↗

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Short and long-term effects of interferon on serum markers of hepatitis C virus replication.

Hepatitis C virus RNA (HCV-RNA) and serological markers of HCV infection were measured in 30 patients with chronic hepatitis C who had been treated with interferon (IFN). Patients were classified into four groups according to serum alanine aminotransferase (ALT) levels after treatment. These were: as complete responders (CR); partial responders (PR); transient responders (TR); and non-responders (NR). In all 11 patients in the CR group, HCV-RNA disappeared from serum for at least 24 months and anti-c100-3 decreased progressively during this time. In the PR group, four of five patients were positive for HCV-RNA in spite of the improvement of ALT levels and decline of anti-c100-3. In the TR and NR groups, HCV-RNA disappeared transiently or remained persistently positive. The results indicate that IFN-mediated improvement of ALT and decrease of anti-HCV (anti-c100-3) were not always related to the disappearance of HCV-RNA from serum. On the other hand, sustained disappearance of HCV-RNA from serum was demonstrated in the patients who did not have post-treatment ALT relapse. This indicates that IFN can eradicate HCV from serum in some patients and provide a clinical remission of chronic hepatitis C.

Alanine Transaminase↗

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Leukemoid reaction associated with parenteral nutrition.

A hematological picture simulating that seen in cases of leukemia often occurs in a variety of conditions. We recently treated a patient who had a leukemoid reaction in the peripheral blood while he was on parenteral nutrition. Throughout the period of treatment with parenteral nutrition, an abnormal shift towards immaturity in the neutrophilic granulocytes was seen, and the degree of this shift appeared to depend on the caloric intake. Moreover, the hematological picture resembling that seen in cases of leukemia disappeared shortly after discontinuation of the parenteral nutrition, and immature cells were no longer apparent. We assumed that the excess glucose-related calories included in parenteral nutrition produced the leukemoid reaction in this patient who was being surgically treated for carcinoma of the colon with hepatic metastasis.

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