Background Although proximal gastrectomy (PG) is widely accepted as a function-preserving operation for early upper-third gastric cancer, postoperative disorders, such as reflux or gastric stasis, have often been pointed out. From the perspective of postoperative disorder, the choice of total gastrectomy (TG) or PG for such cancers is still controversial. By using the newly developed Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, the quality of life after TG and PG was compared. Methods The PGSAS-45 consists of 45 items composed of the SF-8 and GSRS scales and 22 new items. The main outcomes are measured by seven subscales (SS) covering symptoms, physical and mental component summary (SF-8), meals (amount and quality), ability to work, dissatisfaction for daily life, and change in body weight. A total of 2,368 eligible questionnaires were acquired from 52 institutions. From these, 393 patients with TG and 193 patients with PG were selected and compared. Results The PG was better than TG in terms of body weight loss (TG 13.8 % vs. PG 10.9 %; p = 0.003), necessity for additional meals (2.4 vs. 2.0; p \ 0.001), diarrhea SS (2.3 vs. 2.0; p = 0.048), and dumping SS (2.3 vs. 2.0; p = 0.043). There were no differences in the other main outcome measures.Conclusions Proximal gastrectomy appears to be valuable as a function-preserving procedure for early upperthird gastric cancer.

Phospholipase D is believed to play an important role in cell proliferation and tumorigenesis. One of its major functions is to cause a sustained activation of protein kinase C through the primary production of phosphatidic acid from phosphatidylcholine by the enzyme, followed by dephosphorylation forming diacylglycerol. Protein kinase C is known to be activated or translocated in some tumors including breast tumors. In order to examine phospholipase D activity in breast tumors, surgical specimens of human breast tumors were obtained by mastectomy or wide excision, and their phospholipase D activities were assayed by determining the formation of phosphatidylethanol from phosphatidylcholine and ethanol. Phospholipase D activity was predominantly localized in the microsomal fraction of the tumor tissue and markedly stimulated by oleic acid. We observed a significant increase in phospholipase D activity in 17 out of 19 spontaneous human breast tumors as compared to adjacent histologically normal breast tissue. The mean specific activity in the tumors was 52.9 +/- 41.8 (SD) pmol min-1 mg protein-1 whereas the value for the normal breast tissue was 34.0 +/- 36.2 (SD) pmol min-1 mg protein-1 (P < 0.01; paired Wilcoxon's rank-sum test). The mean tumor/normal activity ratio was 2.37. Among prognostic factors, the nuclear grade, evaluated according to Schnitt et al., was found to be correlated with the activity ratio. Our results suggest a role for phospholipase D in human breast tumors. An elevation in phospholipase D activity is useful as a potential marker for malignant disease in the breast.

This report describes a rare case of a schwannoma that developed in the left breast of a 45-year-old woman without von Recklinghausen's disease. The patient complained of a mass growing slowly in her breast for more than 4 years. She did not have any pain and denied any discharge from her nipple. A physical examination revealed a 3.1 x 2.3-cm, elastic-soft, smooth, and mobile lump close to the nipple of the left breast. Mammography revealed a circumscribed, oval-shaped, and equal dense nodule without microcalcification. On ultrasonography the lesion was found to be a well-demarcated, hypoechoic mass including a large cystic area, which led to the suspicion of a phyllodes tumor. An excisional biopsy was performed. A microcopic examination revealed a structure with interlacing bundles of numerous elongated spindle-shaped cells with a typical palisading pattern. These findings were compatible with schwannoma. A review of the English literature yielded 21 proven cases of breast schwannoma. In this report, we describe another such case and review those documented in the literature.

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