Biomedical subjects
Publications and source records attributed to Y Oguro.
A severe case of Vogt-Koyanagi-Haradi's disease was treated with a combination therapy of cyclosporin A and steroid. The therapy was successful and showed no side effects.
The use of local interstitial hyperthermia using a low powered Nd: YAG laser (known as laserthermia) has been studied both in vivo and in vitro on two gastrointestinal carcinomas. Human pancreatic carcinoma subcutaneously transplanted into nude mice (n = 28) was treated using an interstitially placed frosted sapphire probe with a Nd: YAG laser at 3 watts maintaining a temperature increase of 42 degrees C - 43 degrees C for up to 20 minutes. Seven days after treatment, a marked necrosis of the pancreatic tumor was found resembling an ischemic infarction. The potential cytocidal effect of heat and low powered Nd: YAG laser energy was also tested in vitro using three different kinds of human gastric and pancreatic cancer cells. The cytocidal effect of heat was potentiated by the photolytic effect of the low powered Nd: YAG laser energy.
We carried out a clinicopathologic and endoscopic investigation of the relationship between the presence/absence of lymph node or distant metastasis and several crucial factors using resected specimens of early gastric cancer, and concluded that endoscopic treatment was indicated for four types of early gastric cancer: 1) type IIa less than 2 cm in size, 2) focal cancer, 3) so called "gastritis-like" early cancer less than 2 cm in size and 4) polypoid type with mucosal involvement. Up to now, cases of early gastric cancer have been treated by polypectomy, strip biopsy and laser endoscopy. Residual cancer cells were found in 10 out of 20 resected cases. In 2 out of 54 cases followed up for more than one year without any surgical treatment, cancer cells were discovered by biopsy. The effectiveness rate was estimated to be 84% (62/74). Endoscopic treatment was able to provide high efficiency for early gastric cancer of the above types. Causes of ineffectiveness were a lesion more than 2 cm in size, vertical invasion of the lesion into the submucosa and the location of a lesion in a difficult area such as the prepylorus or the cardia.
Endoscopic photodynamic therapy has been used in the treatment of 19 cases of upper gastrointestinal cancer of which six were superficial esophageal and 13 were early gastric cancer. Six patients subsequently underwent surgical resection. Residual tumors were found in the resected specimens of one esophageal carcinoma and in the two early gastric carcinomas. Technical problems resulted in one failure. Follow-up ranged from 4 months to 3 years and 11 months with no tumor recurrence in either the operated or unoperated patients. Other delivery systems are currently under investigation.
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In the 109 subjects adopted for study, 52 involving gastric cancer and 57 noncancerous gastric disease, immunoreactive CEA (GI-SEA) in the gastric juice collected during endoscopy was measured by enzyme immunoassay using polyclonal (P group) and monoclonal (M group) antibodies against CEA. The results are outlined below. The mean value and the positivity of GI-CEA was the highest in advanced gastric cancer, followed by early gastric cancer and noncancerous gastric disease, in that order, and a particularly significant difference (P less than 0.001) was noted (in both the P and M groups) between the former two and the latter. In the GI-CEA of gastric cancer, high positivity was manifested regardless of the histological type, though the average values show that, in the case of the P group, high positivity manifested itself in undifferentiated adenocarcinoma, while in the case of the M group, it applied to differentiated adenocarcinoma. Moreover, no correlation was found between the size of the lesion and the positivity, though even with small lesions of less than 2 cm, there was an indication of probable high positivity. The values recorded for the P and M groups showed a close correlation between the two, except for the GI-CEA value of the histological type. However, for the M group, the positivity and GI-CEA value both tended to be low. The above results suggest that measurement of GI-CEA is of great help in the diagnosis of gastric cancer and that the use of polyclonal antibodies is appropriate for screening and early diagnosis.
The fluorescein kinetics in the vitreous was simulated with a computer to consider several factors such as permeability of the blood-retinal barrier, outward active transport, plasma fluorescein dynamics, diffusion of fluorescein in the vitreous, and fluorescein leakage from the blood-aqueous barrier. Kinetic vitreous fluorophotometry was performed in normal individuals to estimate the inward and outward permeability of the blood-retinal barrier based on the theory of the simulation model. The results of the simulation studies suggest that the fluorescein concentration in the posterior vitreous after intravenous administration is dependent mainly on the inward permeability and on the plasma concentration and that the outward permeability has little influence on the fluorescein kinetics at the early phase. In the pharmacokinetic analysis of the results of kinetic vitreous fluorophotometry, we obtained average values of 1.8 X 10(-5) cm/min and 5.6 X 10(-4) cm/min for the inward permeability and outward permeability coefficients, respectively. The diffusion coefficient of fluorescein in the vitreous was estimated at 7.9 X 10(-4) cm2/min on the average. The outward permeability of the blood-retinal barrier is approximately 31 times the inward permeability. This suggests that a facilitated process that transports fluorescein outward from the vitreous cavity exists in the blood-retinal barrier of human eyes.
Since 1971, when the first draft of the "Group Classification", which classifies the atypism of histological structure in biopsy specimens of the stomach, was proposed by the Japanese Research Society For Gastric Cancer, this classification has come into wide use in Japan. It was, however, revised in 1983, and, according to the revised classification, group III was defined as general histological findings in which it is difficult to make a differentiation between benign and malignant by biopsy specimens. Consequently, the new group III includes, various borderline histologies, in addition to the old group III, which had been defined as the histological features corresponding to those observed in gastric adenoma in biopsy specimens. At the National Cancer Center Hospital, 13,909 gastric biopsies were performed during the period between 1973 and 1982. By retrospective review of these, histological findings in 247 lesions of 231 cases corresponded to group III by the old classification (adenomatous type) and in addition to these, 54 lesions of 54 cases to group III by the new classification (non-adenomatous type). We compared the endoscopic and pathological features between the two types, and the following results were obtained: The false-negative rate of malignancy in the non- adenomatous type (24%) was much higher than that in the adenomatous type (6%). The difference between the two may suggest that, with the adoption of the new group classification, clinical treatment of the patients with group III becomes more complicated due to the increase of the false-negative rate. Endoscopically, most (84%) of the lesions in the adenomatous type were seen as polypoid, while in the non-adenomatous type, depressed lesions were dominant (80%). And, endoscopic details of the polypoid or depressed appearances were mostly different between the two types. These nuances of endoscopic appearance between adenomatous and non-adenomatous types are applicable to decisions regarding, adequate clinical treatment for patients diagnosed as group III by the new "group classification." Good communication between the endoscopist and pathologist is indispensable.
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Fundic gland area gastric polyps in familial polyposis coli (FPC) were compared with those in non-familial polyposis coli clinicopathologically to elucidate their histogenetic and biological characteristics. Some differences were observed in age, sex, and radiological and endoscopical features. Although the polyps were similar histologically, they showed an apparent histochemical difference between the two groups in periodic borohydride technique/potassium hydroxide/periodic acid-Schiff stain which demonstrates O-acylated sialic acid. The superficial and foveolar epithelium of the polyps was positive in 10 of 12 familial polyposis coli cases, while the epithelium was positive in only one of 13 non-familial polyposis coli cases with the same staining. These results suggest differences between the two groups in the degree of epithelial intestinal metaplasia. The presence of gastric polyps with O-acylated sialic acid therefore indicates the necessity of examination of the colorectum.
At the National Cancer Center, 1,300 patients with early gastric cancer were operated on during a period of 21 years, from 1962 to the end of May 1983, and the chronological sequence of the pathological features was analyzed by dividing the 21 years into five periods (I approximately V). The number of elderly patients, especially those above the age of 70 years increased with time, reaching about 20% of all patients in the later period. As to the CMA classification, lesions in A region (antral region) tended to increase, reaching 32.8% in the last period. Lesions on the anterior and posterior wall increased, reaching 20.2% and 30.5%, respectively. Lesions on the greater curvature side were almost unchanged in frequency. The depressed type of carcinoma tended to increase in frequency in the later period, accounting for 75.3% of the total. The depressed type lesions, especially those consisting mainly of IIc element, were therefore subdivided into deep IIc and shallow IIc. In the later period, shallow IIc or not readily detected indistinct IIc increased markedly, reaching 83.3% in Period V. In the initial period, 40% of the lesions were larger than 5 cm. In the later period, lesions larger than 5 cm decreased to 10%, and more than 40% were 2 cm or smaller. Histologically, differentiated and undifferentiated types were found at almost the same frequency. In the later period, the differentiated type became more frequent, reaching as much as 58.2%. Ulcerative lesions (presence of ulcers or ulcer scars in the cancerous lesions) comprised more than 90% of depressed type early gastric cancer, but gradually decreased to 71.9% in the later period. From these findings, early gastric cancer may be said to be changing. Factors contributing to such changes were studied with reference to the progress and multiplication of diagnostic techniques, changes in age composition of the population and changes in environmental factors.
In order to make the endoscopic diagnosis of early gastric cancer more accurate, we determined the endoscopic and clinicopathological characteristics of the 129 cases of early gastric cancer with less malignant appearance among the 978 cases of the disease with a solitary lesion detected at the National Cancer Center Hospital during the period between 1962 and 1981. According to findings required to make a differential diagnosis, the endoscopic appearance of the 978 cases were divided into the following four groups: 170 cases of polypoid, 587 of ulcerative, 119 of gastritis-like and 102 of advanced cancer-like. Among the four groups, the frequency of cases with less malignant appearance was quite high in the gastritis-like group. The lesion in this group was defined as the cancerous lesion which shows only superficial mucosal abnormality, not associated with any polypoid or ulcerative components. Chronologically, it has been rapidly increasing in recent years. These two paradoxical phenomena in the gastritis-like group, that is, "high frequency of less malignant appearance" and "increase in number of cases" not only indicate the inadequacy of the conventional criteria for the recent cases but also show that the gastritis-like malignancy is detectable. New additional endoscopic criteria for the gastritis-like malignancy, for example, irregular margin of the shallow mucosal depression, disproportion of the mucosal granularity, irregularity on the erythematous change and discoloration are essential in order to detect much more cases with less malignant appearance.
In order to determine the reliability of endoscopic biopsy in diagnosis of early gastric cancer, and to clarify the problems with biopsies, preoperative endoscopic biopsies from 771 early gastric cancer cases were reviewed and analyzed clinicopathologically in comparison with surgically resected specimens. The 771 cancers were surgically resected at the National Cancer Center Hospital during the period from 1972 to 1982. Definite histological diagnosis was obtained in 87.4% of the carcinomas at the initial biopsies. Repeated biopsy raised the percentage of correct definite diagnoses to 96.1%. False-negative (including suspicion of cancer) diagnosis was most frequent in the case of depressed lesions (50 lesions). Half of the false negatives were found to be due to sampling errors by the endoscopists. The other half of these 50 lesions were diagnosed as "suspicious of malignancy" because of the histological difficulty in differentiating early gastric cancer from regenerative atypia with intestinal metaplasia, or because there was not enough information, or for the other reasons. Most of the 31 false-negative diagnoses at the initial biopsy from elevated lesions were reported as adenoma (group III) or suspicious of carcinoma (group IV), indicating that differential diagnosis between well-differentiated adenocarcinoma and adenoma is very difficult. The result of the present study suggests that repeated biopsy from correct sites and discussion of the lesions between clinicians and pathologists are very important.
With the tremendous development of gastroenterological endoscopy, it has become possible to treat some types of early gastric cancer by endoscopy. There are two principal methods for this purpose, endoscopic polypectomy using a high frequency electric current and laser endoscopy. We developed the technic and instruments of endoscopic polypectomy, in 1972. Since then, we have experienced 358 cases of gastric polypoid lesions treated by endoscopic polypectomy. Nineteen patients with the elevated type of early gastric cancer were treated by endoscopic polypectomy. Seven patients were operated on after polypectomy and 12 were followed without surgery. Out of the 12 patients, nine are alive after more than five years. On the other hand, we started research to apply lasers for treating early gastric cancer in 1978. Since then, 18 patients have been treated by laser endoscopy, with Nd-YAG laser, argon dye laser or a combination of both lasers. We have established criteria for these treatments for early gastric cancer.
Present condition and activities of Jeddah Endoscopy Center managed in cooperation with Saudian and Japanese doctors are reported. Total number of patients examined are 1,183 cases; 73% of which were subjected to endoscopy and 27% were to fluoroscopy. With respect to the stomach diseases, gastric cancer and ulcer were found in 16% and 14.7%, respectively. On the other hand, high incidences of severe atrophic gastritis and haemorrhagic or erosive gastritis accounted totally 64.7% of all stomach diseases were noted. Out of 264 cases of duodenal diseases, duodenal ulcer was diagnosed in number of 202 cases (76%). The ratio between gastric and duodenal ulcer was, therefore, approximately 1:6. It was further noted that most of patients with esophagus cancer were found in males having the local habit of taking green tobacco. From the results obtained, discussions were made on the statistical differences of gastrointestinal diseases between Saudi Arabia and Japan.
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