It is considered that immunohistochemical analysis of DPD expression in gastric carcinoma using biopsied tissue is a technically feasible method to assess the expression of DPD in the tumor prior to surgical resection.

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Some studies have shown reduced portal blood flow in patients with occult hepatic metastases, which may lead to decreased liver volume. A retrospective study was conducted in patients undergoing curative resection for colorectal (n = 63) or gastric (n = 52) cancer. The ratio of the preoperative computed tomography (CT)-estimated liver volume to the standard liver volume (CV/SV ratio) was calculated. The mean +/- SD CT-estimated liver volume was 858 +/-109 in 14 patients who subsequently developed hepatic metastases and 1173 +/- 230 ml in 101 patients without metastases (p < 0.0001). The CV/SV ratio was smaller in patients with metachronous hepatic metastases than in those without (0.78 +/- 0.08 vs. 1.02 + 0.13; p < 0.0001). The results suggest that the liver with occult metastases decreases in size before metastases develop that are detectable using conventional imaging techniques. The CV/SV ratio may be of value in detecting occult hepatic metastases from colorectal and gastric cancer.

The influence of biliary diversion upon gastric acid secretion and the serum gastrin level was investigated in dogs with Heidenhain pouch. Biliary diversion was carried out by the following operative procedures: 1) External biliary fistula (3 dogs), ligation and division of the common bile duct and construction of an external biliary fistula by inserting a cannula into the gallbladder. 2) Roux-en-Y internal biliary fistula (6 dogs), ligation and division of the common bile duct and construction of an internal fistula (cholecystojejunostomy) by anastomosing the gallbladder to the jejunum 10 cm distal to the ligament of Treitz, with restoration of end-to-side jejunojejunostomy. In each dog, a test meal (Dog Food, 300 g) was administered, and the gastric acid secretion and serum gastrin level were examined. In the external biliary fistula, the gastric acid secretion showed no increase after the test meal, while in the Roux-en-Y internal fistula the secretion from the Heidenhain pouch showed a significant increase in 4 of 6 dogs, with an increase rate of 110-330%. In either the external biliary fistula or the Roux-en-Y internal fistula, the serum gastrin level showed no significant change. However, in the dogs with the Roux-en-Y internal fistula allotted for the observation periods of 4 to 5 months, the serum gastrin level at 3 hr after the test meal was significantly higher than that at fasting. Further, in pursuit of the reproducibility of gastric acid secretion with the Roux-en-Y internal biliary fistula in the course between the first and second Roux-en-Y internal fistulae, the gastric acid secretion markedly increased in the cases of the Roux-en-Y internal fistula, without definite changes in the level of serum gastrin. Acute gastric ulcer developed in 2 of 6 dogs with the Roux-en-Y internal biliary fistula, but no fat indigestion was caused. These results suggest that gastric hypersecretion induced by biliary diversion may prove the possibility of presence of gastric secretagogue, different from gastrin, released in the upper jejunum. biliary diversion; internal biliary fistula; gastric acid secretion; serum gastrin level Biliary-intestinal anastomoses are used for reconstruction of the biliary tract. It has been pointed out that the surgical procedure for reconstruction of the biliary tract, particularly choledochoj ej unostomy, is likely to give rise to peptic ulcer. Recently, McArthur and Longmire (1971) reported an increased incidence of peptic ulcer in a relatively large series of patients who had undergone choledochojejunostomy for benign biliary obstruction. However, the possible

We report herein a rare case with advanced gastric cancer combined with group 4 lymph node and lung metastases that responded remarkably to neoadjuvant chemotherapy. A 65-year-old man was found to have a well-differentiated type 3 gastric cancer that invaded the duodenum locally and was accompanied with Virchow's, para-aortic lymph nodes, and multiple lung metastases based on physical, endoscopic, and radiological examinations. In addition, his carbohydrate antigen (CA) 19-9 was elevated to 3965U/ml, and CA72-4 to 46U/ml. Prior to surgery, he was treated with 5-fluorouracil (5-FU; 500mg/body per day) and low-dose cisplatinum (CDDP; 10mg/body per day) as neoadjuvant chemotherapy for 6 weeks. As a result, a partial response was obtained in all lesions, and CA19-9 and CA72-4 decreased to 463U/ml and 9.4U/ml, respectively. Four weeks after the completion of neoadjuvant chemotherapy, a distal gastrectomy was performed, and a histopathological examination of the resected specimen showed a grade 2 response to chemotherapy. Immunohistochemically, the thymidylate synthase expression level was very low in the tumor tissues, which might account for the good response to the combination chemotherapy with 5-FU and CDDP observed in the present case.